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Acta Obstet Gynecol Scand. 2018 Nov 10. doi: 10.1111/aogs.13502. [Epub ahead of print]

Malpresentation in low- and middle-income countries: associations with perinatal and maternal outcomes in the Global Network.

Author information

1
Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
2
Social, Statistical and Environmental Health Sciences, Durham, NC, USA.
3
Aga Khan University, Karachi, Pakistan.
4
Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo.
5
University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
6
University Teaching Hospital, Lusaka, Zambia.
7
University of Alabama at Birmingham, Birmingham, AL, USA.
8
Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala.
9
University of Colorado Denver, Denver, CO, USA.
10
KLE Academy of Higher Education and Research's J N Medical College, Belagavi, India.
11
Thomas Jefferson University, Philadelphia, PA, USA.
12
Lata Medical Research Foundation, Nagpur, India.
13
Boston University, Boston, MA, USA.
14
Moi University, Eldoret, Kenya.
15
Indiana University, Indianapolis, IN, USA.

Abstract

INTRODUCTION:

Uncertainty exists regarding the impact of malpresentation on pregnancy outcomes and the optimal mode of delivery in low- and middle-income countries. We sought to compare outcomes between cephalic and non-cephalic pregnancies.

MATERIAL AND METHODS:

Using the NICHD Global Network's prospective, population-based registry of pregnancy outcomes from 2010-2016, we studied outcomes in 436,112 singleton pregnancies. Robust Poisson regressions were used to estimate the risk of adverse outcomes associated with malpresentation. We examined rates of cesarean delivery for malpresentation and compared outcomes between cesarean and vaginal delivery by region.

RESULTS:

Across all regions, stillbirth and neonatal mortality rates were higher among deliveries with malpresentation. In adjusted analysis, malpresentation was significantly associated with stillbirth (adjusted relative risk (aRR) 4.0, 95% confidence interval (CI); 3.7 to 4.5) and neonatal mortality (aRR 2.3, 95% CI; 2.1 to 2.6). Women with deliveries complicated by malpresentation had higher rates of morbidity and mortality. Rates of cesarean delivery for malpresentation ranged from 27% to 87% among regions. Compared to cesarean, vaginal delivery for malpresentation was associated with increased maternal risk, especially postpartum hemorrhage (aRR 5.0, 95% CI; 3.6 to 7.1).

CONCLUSIONS:

In a cohort of deliveries in low- and middle-income countries, malpresentation was associated with increased perinatal and maternal risk. Further research is needed to determine the best management of these pregnancies. This article is protected by copyright. All rights reserved.

KEYWORDS:

Breech Presentation; Cesarean Section; Developing Countries; Labor Presentation; Obstetric Delivery; Pregnancy Outcomes

PMID:
30414270
DOI:
10.1111/aogs.13502

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