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J Bone Joint Surg Br. 2010 Dec;92(12):1695-9. doi: 10.1302/0301-620X.92B12.24960.

The relationship between mode of delivery and developmental dysplasia of the hip in breech infants: a four-year prospective cohort study.

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Department of Orthopaedics, East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital, Haslingden Road, Blackburn BB2 3HH, UK.


This prospective cohort study aimed to investigate the relationship between developmental dysplasia of the hip and mode of delivery in 571 consecutive breech infants using a modified Graf's static morphological method to grade the severity of dysplasia. In this group, 262 infants were born by planned Caesarian section, 223 by emergency section and 86 vaginally. Taking all grades of hip dysplasia into account (Graf types II, III and IV), there was no statistical difference in the incidence of dysplasia between the groups (elective section 8.4%, emergency section 8.1% and vaginal delivery 7.0%). However, when cases with Graf type II dysplasia, which may represent physiological immaturity, were excluded, the rate of type III and IV hips, which we consider to be clinically relevant, increased in the vaginally delivered group (4.7%) compared with the elective section group (1.1%), with a relative risk of approximately 1:4 (95% confidence interval 1.03 to 15.91). No difference was observed between the emergency and elective section groups, or between the emergency section and vaginally delivered groups. This study supports previous published work, with the added value that the diagnoses were all confirmed by ultrasound.

[Indexed for MEDLINE]

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