BREECH AT TERM - MODE OF DELIVERY - A REGISTER-BASED STUDY

Background. The present study was designed to determine neonatal morta lity and morbidity in non-malformed singleton term infants delivered i n breech presentation and identify a possible correlation between outc ome on the one hand and mode of delivery, parity and birth weight on t he other. Methods. Register-based cohort study of all (n=15718) single ton term breech deliveries of non-malformed infants in Denmark 1982-19 90. Process and outcome measures: mode of delivery, gestational age, b irth weight, congenital malformations, intrapartum death, Apgar scores and early neonatal death. Results. A total of 3247 (20.7%) term infan ts were delivered vaginally, 7106 (45.3%) by elective and 5356 (34.1%) by emergency cesarean section. Infants delivered vaginally and by eme rgency cesarean section had significantly higher rates of mortality (i ntrapartum and early neonatal death) and morbidity (low Apgar scores) when compared to those delivered by elective cesarean section. In vagi nal deliveries, parity was not correlated with outcome, but infants wi th a birth weight above 4000 grams had significantly higher rates of l ow Apgar scores. Conclusions. Register data on singleton term breech d eliveries imply that vaginal delivery is associated with increased mor tality and morbidity. However, validation of data and additional infor mation from the medical records are needed before a recommendation of whether selection of parturients, structure of perinatal care or profe ssional skills need to be improved, or all singleton term infants in b reech presentation should be delivered by cesarean section.