BREECH DELIVERY IN VERY PRETERM AND VERY-LOW-BIRTH-WEIGHT INFANTS IN THE NETHERLANDS

Objective To study the relation between various perinatal factors and the sequelae of very preterm birth, applying logistic regression analy sis. Design In a nationwide collaborative study in the Netherlands, pe rinatal and follow up data were collected on 899 liveborn singleton no nmalformed infants with gestational age less than 32 weeks or birthwei ght less than 1500 g born in 1983. Main outcome measures Neonatal mort ality rate and total handicap rates (minor and major) in surviving chi ldren at two years and five years of age. Results Comparing breech wit h vertex presentation, the odds ratio for neonatal mortality (adjusted for duration of pregnancy, birthweight, maternal hypertension and pro longed rupture of membranes) is 1.6 (P<0.05). Comparing abdominal vers us vaginal delivery, the odds ratio indicates equal risks. When breech and vertex presentation are analysed separately it appears that breec h presenting infants have a significantly lower mortality risk when bo rn by caesarean section compared with vaginal delivery. However, compa ring abdominal versus vaginal delivery in breech presentation, the odd s ratio for handicap at five years (0.9) is not significantly differen t from 1. Conclusion The data presented suggest a reduced neonatal mor tality rate in breech presenting infants born by caesarean section but because of the observational design of the study the statistical anal ysis described only identifies a possible trend and cannot prove the i ssue.