Mahmoud A. Ismail, Nabeel Nagib, Tammie Ismail, Luis A. Cibils
Comparison of vaginal and cesarean section delivery for fetuses in breech presentation
Objectives: Our purpose was to evaluate the perinatal
mortality and morbidity of deliveries with fetuses presenting
by the breech comparing outcomes of two
groups according to mode of delivery: vaginal and cesarean
section.
Results: Of 756 fetuses studied, 271 were delivered vaginally
and 485 by cesarean section. In infants weighing
? 1500 grams, “further corrected” mortality and morbidity
rates were low and similar for both delivery
routes: one neonatal death (NNM) in each. Among very low birth weight (VLBW) infants (< 1500 grams) the
“further corrected” mortality rate was higher in the vaginal
group: 57.4%, and 18.0% in abdominal deliveries
(odds ratio [OR] = 6.1, 95% CI: 3.1 to 12.1). Likewise,
rate of depression at five minutes were higher in the
vaginal group (p < 0.001). However, the average fetal
weight among the vaginal deliveries VLBW (787
grams) was 250 grams less than in the cesarean section
group (1040 grams). After adjustment for fetal weight,
gestational age, and other prognostic variables the odds
ratio for neonatal death was no longer statistically significant
(adjusted OR = 2.1, 95% CI: 0.9 to 5.2,
p = 0.105). Comparison of planned vaginal delivery
with elective cesarean section yielded smaller differences
(adjusted OR for neonatal death = 1.3, 95% CI:
0.6 to 2.9, p = 0.525).
Conclusion: The poor perinatal outcomes of breech delivered
infants are due primarily to VLBW, congenital malformations, and premature labor. Although abdominal
delivery had a lower NNM rate than vaginal delivery,
the difference was not significant after adjustment
for confounding factors. The results confirm the findings
of a previously analyzed similar series delivered at
our institution between 1980 and 1987. They suggest
that, with appropriate technique, abdominal delivery is
not mandatory in breech presentation.
Journal of Perinatal Medicine, Walter de Gruyter
Print ISSN: 1619-3997
Volume: 27, 11/1999
Pages: 339 - 351
Show full article (external site)
Show all available items of this journal
Search
