Outcomes of breech birth by mode of delivery: a population linkage study

Abstract

Background: Trial evidence supports a policy of caesarean section for singleton breech presentations at term but vaginal breech birth is considered a safe option for selected women. Aims: To provide recent Australian data on outcomes associated with intended mode of delivery for term breech singletons in women who meet conservative eligibility criteria for vaginal breech birth. Materials and Methods: Birth and hospital records from 2009 to 2012 in New South Wales were used to identify women with non-anomalous pregnancies who would be considered eligible for vaginal breech birth. Intended mode of delivery was inferred from labour onset and management. Results: Of 10,133 women with term breech singleton pregnancies, 5,197 (51.3%) were classified as eligible for vaginal breech delivery. Of these, 6.8% intended vaginal breech birth, 76.4% planned caesarean section, and intention could not be determined for 16.8%. Women intending vaginal delivery had higher rates of neonatal morbidity (6.0% vs. 2.1%), neonatal birth trauma (7.4% vs. 0.9%), Apgar <4 at 1 minute (10.5% vs. 1.1%), Apgar<7 at 5 minutes (4.3% vs. 0.5%), and NICU/SCN admissions (16.2% vs. 6.6%) than those planning caesarean section. Increased perinatal risks remained after adjustment for maternal characteristics. Severe maternal morbidity (1.4% vs. 0.7%) and postpartum readmission (4.6% vs. 4.0%) were higher in the intended vaginal compared to planned caesarean births but these differences were not statistically significant. Conclusions: In a population of women classified as being eligible for vaginal breech birth, intended vaginal delivery was associated with higher rates of neonatal morbidity than planned caesarean section.