PREGNANCY OUTCOMES BY MODE OF DELIVERY AMONG TERM BREECH BIRTHS - SWEDISH EXPERIENCE 1987-1993

Objective: To study the influence of mode of delivery on infant mortal ity, neonatal morbidity, and maternal morbidity in pregnancies with no nmalformed term singleton infants presented in breech. Methods: We stu died all nonmalformed live-born singleton infants, delivered at term ( at 37 weeks or later) in breech position in Sweden between 1987 and 19 93 (n = 15,818). The pregnancy outcomes analyzed were neonatal and inf ant mortality, low Apgar score (less than 7) at 5 minutes, birth injur y, and neonatal convulsions. Severe perineal or vaginal lacerations, w ound rupture, infections, and thrombosis were used as measures of mate rnal morbidity. Logistic regression analysis was used to determine ris ks of infant mortality and morbidity, after adjusting for a number of potential confounders. Results: Compared with infants delivered by ele ctive cesarean, infants delivered vaginally were at significantly high er risk for infant mortality (odds ratio [OR] 2.5). Infants delivered vaginally were at increased risk for birth injury (OR 12.2), and infan ts delivered by emergency cesarean were at increased risk for neonatal convulsions (OR 4.1). Infants delivered vaginally or by emergency ces arean were at increased risk for a low Apgar score at 5 minutes. Mater nal morbidity was highest among women who delivered by emergency cesar ean (2.8%), whereas lower rates were obtained among women who delivere d vaginally and those who delivered by elective cesarean (1.8 and 1.7% , respectively). Conclusion: Vaginal delivery of term infants presente d in breech is associated with higher risks of neonatal mortality and morbidity compared with delivery by elective cesarean. We conclude tha t term singleton infants presented in breech would benefit from an ele ctive cesarean delivery. (Obstet Gynecol 1998;92:945-50. (C) 1998 by T he American College of Obstetricians and Gynecologists.).