The relation of breech presentation at term to cerebral palsy

Objective To examine the relation between breech delivery and cerebral pals y, considering the influence of intrauterine growth, low Apgar score at bir th, and mode of delivery. Design Register-based, case-control study. Population A cohort of infants with cerebral palsy born between 1979 and 19 86 in East Denmark, identified by linkage of the cerebral palsy register wi th the national birth register. Discharge letters from births of breech inf ants with cerebral palsy were reviewed. Main outcome measures Presentation, mode of delivery, gestational age, birt hweight, Apgar score, type of cerebral palsy, severity of handicap. Results Breech presentation at term was associated with a borderline signif icantly higher risk of cerebral palsy than vertex presentation (OR 1.56; 95 % CI 0.9-2.4). Breech presentation infants more often had a lower Apgar sco re (< 7 at 5 minutes) and were smaller for gestational age (SGA < 2 SD) tha n were those with vertex presentation; infants with a low Apgar score, or w ho were small for gestational age, had a higher risk of cerebral palsy. Aft er stratification by being small for gestational age the risk of cerebral p alsy was not related to presentation. There were no differences between bre ech and vertex infants with cerebral palsy in terms of low Apgar score, bei ng small for gestational age, mode of delivery, and severity of the handica p. Breech presentation infants were more often classified as diplegic (77.8 % versus 42.3% in cephalic infants). Conclusion The risk of cerebral palsy among term breech presentation infant s does not seem to be related to mode of delivery, but is more likely linke d to a higher rate of being small for gestational age in breech infants.