FACTORS INFLUENCING NEONATAL OUTCOMES IN THE VERY-LOW-BIRTH-WEIGHT FETUS (LESS-THAN-1500 GRAMS) WITH A BREECH PRESENTATION

OBJECTIVES: Our purpose was to evaluate factors that may influence per inatal outcomes in the very-low-birth-weight infant with breech presen tation. STUDY DESIGN: An observational study that included all consecu tive singletons and twins with the first fetus with breech presentatio n weighing between 500 and 1500 gm delivered at Chicago Lying-in Hospi tal from July 1980 to December 1987 was performed. Uncorrected and cor rected perinatal mortality and morbidity were calculated. After correc tion, the effect of mode of delivery (vaginal versus cesarean section) was studied. A further correction was made by excluding cesarean sect ions performed for fetal distress. Statistical methods included chi(2) and Fisher exact tests and logistic regression analyses to calculate unadjusted and adjusted odds ratios. RESULTS: Of the 262 fetuses studi ed, nearly 60% were delivered vaginally and were of younger gestationa l age and lower fetal weight (300 gm) than those delivered abdominally . Forty-four percent weighed less than or equal to 800 gm, and the per inatal mortality rate was 64.5% (53.3% after correction). Vaginal deli very had higher Fates of depression, respiratory distress syndrome, an d death. Prematurity was the most frequent cause of neonatal death, Th e corrected neonatal mortality was similar to the total inborn populat ion of our neonatal intensive care unit for the same years. Logistic r egression analyses revealed that the differences in outcomes between t he two groups were primarily related to effects of gestational age, fe tal weight, and year of delivery. After these factors were adjusted fo r, the odds of neonatal death for vaginal delivery compared with cesar ean delivery were not significantly different (odds ratio 1.4, 95% con fidence interval 0.6 to 3.5, p = 0.48). However, in the subgroup in fo otling attitude the differences were much greater, with an adjusted od ds ratio of 3.2 (95% confidence interval 0.7 to 14.9, p = 0.13). CONCL USION: The exceedingly poor perinatal outcomes of very-low-birth-weigh t breech infants are mainly related to antenatal deaths (22%), extreme ly low birth weight (44%), congenital malformations, and premature lab or, not to the breech presentation. The route of delivery did not sign ificantly influence outcome among complete and frank attitudes; abdomi nal delivery may offer some benefit for footlings. Prematurity is the primary cause of death of normal very-low-birth-weight breech-delivere d infants.