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Acta Obstet Gynecol Scand. 2001 Aug;80(8):731-7.

Mode of delivery in breech presentation at term: increased neonatal morbidity with vaginal delivery.

Author information

1
Department of Obstetrics and Gynecology, University Hospital of Lund, S-223 85 Lund, Sweden. Andreas.Herbst@gyn.lu.se

Abstract

OBJECTIVE:

To compare the neonatal outcome in planned vaginal delivery and planned cesarean section in term singleton pregnancies with breech presentation in a Scandinavian clinic with a high rate of vaginal breech delivery.

METHODS:

A retrospective study including 1050 term singleton breech pregnancies delivered at a Swedish tertiary referral center during 1988 to 2000. For 699 patients (67%) a vaginal delivery was planned, of whom 603 (86%) were delivered vaginally. In 327 (31%) cases a cesarean section was planned and performed. These two groups were compared regarding rates of acidemia at birth (cord artery pH <7.05), low Apgar scores and neonatal neurological morbidity. Long term sequels among infants with a complicated neonatal course were also identified.

RESULTS:

Acidemia at birth, Apgar score below 7 at 5 minutes, and referral to neonatal intensive care unit all occurred at higher rates in planned vaginal delivery (5.3%, 3.6%, and 8.9%, respectively), than in planned cesarean delivery (0, 0, and 4.0%). The rate of neonatal neurological morbidity was 24/699 (3.4%) in planned vaginal delivery (18 cases with cerebral symptoms and six cases of brachial plexus palsy) compared to one case (cerebral symptoms) after a planned cesarean. These differences were all statistically significant (p< or =0.002). Of the neurologically affected neonates, two died and four had cerebral palsy (one delivered by planned cesarean section) at follow up.

CONCLUSION:

Neonatal morbidity may be reduced with planned cesarean delivery in breech presentation, also in a Scandinavian setting.

Comment in

PMID:
11531616
[Indexed for MEDLINE]

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