MODE OF DELIVERY AND PERINATAL RESULTS IN BREECH PRESENTATION

Citation
L. Brown et al., MODE OF DELIVERY AND PERINATAL RESULTS IN BREECH PRESENTATION, American journal of obstetrics and gynecology, 171(1), 1994, pp. 28-34
Citations number
25
Categorie Soggetti
Obsetric & Gynecology
ISSN journal
00029378
Volume
171
Issue
1
Year of publication
1994
Pages
28 - 34
Database
ISI
SICI code
0002-9378(1994)171:1<28:MODAPR>2.0.ZU;2-7
Abstract
OBJECTIVES: Our purpose was to evaluate the outcome of deliveries with fetuses in breech presentation at labor and to compare the results by route of delivery. Specially reviewed were fetuses weighing greater t han or equal to 1500 gm.STUDY DESIGN: An observational study of consec utive cases of all singleton pregnancies and twin pregnancies with the first fetus presenting in breech delivered at Chicago Lying-in Hospit al from July 1980 to December 1987 was performed. Crude perinatal mort ality and effect of mode of delivery (cesarean vs vaginal) by weight w ere compared after correction for nonpreventable causes. A further cor rection was made for fetuses weighing greater than or equal to 1500 gm by excluding all cases of fetal distress from the cesarean section gr oup. All clinically relevant factors were evaluated. Statistical metho ds included comparison of frequencies in the two groups by chi(2) and Fisher exact tests and comparison of means by two-sample t tests. RESU LTS: Of 21,380 deliveries, 843 (3.9%,) presented by the breech. Forty- four percent were delivered vaginally; 8.4% were first twins. There we re 51% preterm infants, and 24% had clinical distress. Crude perinatal mortality was 24%: 8% stillborns, 10% from prematurity, and 6% from o ther causes, including lethal congenital malformations. The corrected perinatal mortality was 15%. Vaginal deliveries had a higher 5-minute depression rate (32% vs 24%) and corrected perinatal mortality (23% vs 9.6%); however, fetal weights were significantly lower. There were no differences in outcomes for newborns weighing greater than or equal t o 1500 gm by route of delivery; all five neonatal deaths in this subgr oup occurred among the abdominal deliveries. CONCLUSIONS: The very poo r perinatal outcomes in breeches are primarily related to factors othe r than breech presentation. Route of delivery for infants weighing gre ater than or equal to 1500 gm does not influence neonatal outcome; thu s cesarean section solely for breech presentation in this subgroup doe s not appear to be justified,