Is vaginal breech delivery associated with higher risk for perinatal death and cerebral palsy compared with vaginal cephalic birth? Registry-based cohort study in Norway
Objective This paper aims to study if vaginal breech delivery is associated with increased risk for neonatal mortality (NNM) or cerebral palsy (CP) in Norway where vaginal delivery accounts for 1/3 of all breech deliveries.Design Cohort study using information from the national Medical BirthRegister...
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BMJ Publishing Group
2017-05-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/7/4/e014979.full |
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| author | Guro L Andersen Solveig Bjellmo Sissel Hjelle Pål Richard Romundstad Torstein Vik Marit Petra Martinussen Dag Moster |
| author_facet | Guro L Andersen Solveig Bjellmo Sissel Hjelle Pål Richard Romundstad Torstein Vik Marit Petra Martinussen Dag Moster |
| author_sort | Guro L Andersen |
| collection | DOAJ |
| description | Objective This paper aims to study if vaginal breech delivery is associated with increased risk for neonatal mortality (NNM) or cerebral palsy (CP) in Norway where vaginal delivery accounts for 1/3 of all breech deliveries.Design Cohort study using information from the national Medical BirthRegister and Cerebral Palsy Register.Setting Births in Norway 1999–2009.Participants 520 047 term-born singletons without congenital malformations.Main outcome measures NNM, CP and a composite outcome of these and death during birth.Results Compared with cephalic births, breech births had substantially increased risk for NNM but not for CP. Vaginal delivery was planned for 7917 of 16 700 fetuses in breech, while 5561 actually delivered vaginally. Among these, NNM was 0.9 per 1000 compared with 0.3 per 1000 in vaginal cephalic delivery, and 0.8 per 1000 in those actually born by caesarean delivery (CD) in breech. Compared with planned cephalic delivery, planned vaginal delivery was associated with excess risk for NNM (OR 2.4; 95% CI 1.2 to 4.9), while the OR associated with planned breech CD was 1.6 (95% CI 0.7 to 3.7). These risks were attenuated when NNM was substituted by the composite outcome. Vaginal breech delivery was not associated with excess risk for CP compared with vaginal cephalic delivery.Conclusion Vaginal breech delivery, regardless of whether planned or actual, and actual breech CD were associated with excess risk for NNM compared with vaginal cephalic delivery, but not with CP. The risk for NNM and CP in planned breech CD did not differ significantly from planned vaginal cephalic delivery. However, the absolute risk for these outcomes was low, and taking into consideration potential long-term adverse consequences of CD for the child and later deliveries, we therefore conclude that vaginal breech delivery may be recommended, provided competent obstetric care and strict criteria for selection to vaginal delivery. |
| format | Article |
| id | doaj-art-b8978790d75148dd81c40b3e0b01d777 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2017-05-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-b8978790d75148dd81c40b3e0b01d7772025-02-08T20:00:17ZengBMJ Publishing GroupBMJ Open2044-60552017-05-017410.1136/bmjopen-2016-014979Is vaginal breech delivery associated with higher risk for perinatal death and cerebral palsy compared with vaginal cephalic birth? Registry-based cohort study in NorwayGuro L Andersen0Solveig Bjellmo1Sissel Hjelle2Pål Richard Romundstad3Torstein Vik4Marit Petra Martinussen5Dag Moster63 The Cerebral Palsy Registry of Norway, Habilitation Center, Vestfold Hospital, Tønsberg, Norway1 Obstetrics and Gynecology, Helse More og Romsdal HF, Aalesund, Norway1 Obstetrics and Gynecology, Helse More og Romsdal HF, Aalesund, Norway9 Department of Public Health, Norwegian University of Science and Technology, Trondheim, Norway2 Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway2 The Norwegian University of Science and Technology, NTNU, Trondheim, Norway3 Institute of Global Public Health and Primary Care, UiB, Bergen, NorwayObjective This paper aims to study if vaginal breech delivery is associated with increased risk for neonatal mortality (NNM) or cerebral palsy (CP) in Norway where vaginal delivery accounts for 1/3 of all breech deliveries.Design Cohort study using information from the national Medical BirthRegister and Cerebral Palsy Register.Setting Births in Norway 1999–2009.Participants 520 047 term-born singletons without congenital malformations.Main outcome measures NNM, CP and a composite outcome of these and death during birth.Results Compared with cephalic births, breech births had substantially increased risk for NNM but not for CP. Vaginal delivery was planned for 7917 of 16 700 fetuses in breech, while 5561 actually delivered vaginally. Among these, NNM was 0.9 per 1000 compared with 0.3 per 1000 in vaginal cephalic delivery, and 0.8 per 1000 in those actually born by caesarean delivery (CD) in breech. Compared with planned cephalic delivery, planned vaginal delivery was associated with excess risk for NNM (OR 2.4; 95% CI 1.2 to 4.9), while the OR associated with planned breech CD was 1.6 (95% CI 0.7 to 3.7). These risks were attenuated when NNM was substituted by the composite outcome. Vaginal breech delivery was not associated with excess risk for CP compared with vaginal cephalic delivery.Conclusion Vaginal breech delivery, regardless of whether planned or actual, and actual breech CD were associated with excess risk for NNM compared with vaginal cephalic delivery, but not with CP. The risk for NNM and CP in planned breech CD did not differ significantly from planned vaginal cephalic delivery. However, the absolute risk for these outcomes was low, and taking into consideration potential long-term adverse consequences of CD for the child and later deliveries, we therefore conclude that vaginal breech delivery may be recommended, provided competent obstetric care and strict criteria for selection to vaginal delivery.https://bmjopen.bmj.com/content/7/4/e014979.full |
| spellingShingle | Guro L Andersen Solveig Bjellmo Sissel Hjelle Pål Richard Romundstad Torstein Vik Marit Petra Martinussen Dag Moster Is vaginal breech delivery associated with higher risk for perinatal death and cerebral palsy compared with vaginal cephalic birth? Registry-based cohort study in Norway BMJ Open |
| title | Is vaginal breech delivery associated with higher risk for perinatal death and cerebral palsy compared with vaginal cephalic birth? Registry-based cohort study in Norway |
| title_full | Is vaginal breech delivery associated with higher risk for perinatal death and cerebral palsy compared with vaginal cephalic birth? Registry-based cohort study in Norway |
| title_fullStr | Is vaginal breech delivery associated with higher risk for perinatal death and cerebral palsy compared with vaginal cephalic birth? Registry-based cohort study in Norway |
| title_full_unstemmed | Is vaginal breech delivery associated with higher risk for perinatal death and cerebral palsy compared with vaginal cephalic birth? Registry-based cohort study in Norway |
| title_short | Is vaginal breech delivery associated with higher risk for perinatal death and cerebral palsy compared with vaginal cephalic birth? Registry-based cohort study in Norway |
| title_sort | is vaginal breech delivery associated with higher risk for perinatal death and cerebral palsy compared with vaginal cephalic birth registry based cohort study in norway |
| url | https://bmjopen.bmj.com/content/7/4/e014979.full |
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