Term breech deliveries in the Netherlands: did the increased cesarean rate affect neonatal outcome? A population-based cohort study
Date
2014
Authors
Vlemmix, F.
Bergenhenegouwen, L.
Schaaf, J.
Ensing, S.
Rosman, A.
Ravelli, A.
Van Der Post, J.
Verhoeven, A.
Visser, G.
Mol, B.
Editors
Advisors
Journal Title
Journal ISSN
Volume Title
Type:
Journal article
Citation
Acta Obstetricia et Gynecologica Scandinavica, 2014; 93(9):888-896
Statement of Responsibility
Floortje Vlemmix, Lester Bergenhenegouwen, Jelle M. Schaaf, Sabine Ensing, Ageeth N. Rosman, Anita C.J. Ravelli, Joris A.M. van der Post, Arno Verhoeven, Gerard H. Visser, Ben W.J. Mol and Marjolein Kok
Conference Name
Abstract
OBJECTIVE: The aim of this study was to evaluate the effect of the increased cesarean rate for term breech presentation on neonatal outcome. We also investigated whether the clinical case selection for vaginal delivery applied by Dutch obstetricians led to an optimization of neonatal outcome, or whether there is still room for improvement in terms of perinatal outcome. DESIGN: Retrospective cohort. SETTING: The Netherlands. POPULATION: Singleton term breech deliveries from 37+0 to 41+6 weeks, excluding fetuses with congenital malformations or antenatal death. METHOD: We used data from the Dutch national perinatal registry from 1999 up to 2007. MAIN OUTCOME MEASURES: Perinatal mortality and morbidity. RESULTS: We studied 58,320 women with a term breech delivery. There was an increase in the elective cesarean rate (from 24 to 60%). As a consequence, overall perinatal mortality decreased [1.3 0/00 vs. 0.7 0/00;odds ratio 0.51 (95% confidence interval 0.28–0.93)], whereas it remained stable in the planned vaginal birth group [1.7 0/00 vs. 1.6 0/00; odds ratio 0.96(95% confidence interval 0.52–1.76)]. The number of cesareans done to prevent one perinatal death was 338. CONCLUSIONS: Adjustment of the national guidelines after publication of the Term Breech Trial resulted in a shift towards elective cesarean and a decrease of perinatal mortality and morbidity among women delivering a child in breech at term. Still, 40% of these women attempt vaginal birth. The relative safety of an elective cesarean should be weighed against the consequences of a scarred uterus in future pregnancies.
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Dissertation Note
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Description
Article first published online: 11 AUG 2014
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© 2014 Nordic Federation of Societies of Obstetrics and Gynecology