Document Detail

Vaginal vs. cesarean delivery for preterm breech presentation of singleton infants in California: a population-based study.
MedLine Citation:
PMID:  17694963     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To examine the morbidity and mortality associated with vaginal breech delivery (VBD) of premature, low-birth-weight (LBW) (< 2.5 kg) newborns as compared to delivery by cesarean section. STUDY DESIGN: A retrospective cohort study of singleton, preterm (< 37 weeks), LBW, nonanomalous newborns in California (January 1, 1991-December 31, 1999) was performed. Neonatal morbidity and mortality by route of delivery were compared. RESULTS: Overall, 14,417 LBW, preterm, breech newborns were delivered (14% vaginally and 86% by cesarean). There were 150,570 LBW, preterm, cephalic newborns, of whom 82% were delivered vaginally. VBD of LBW newborns in nulliparous women was associated with increased neonatal mortality in newborns weighing 500-1,000 g (OR 11.7; 95% CI 7.9, 17.2), 1,001-1,500 g (OR 17.0; 95% CI 6.8, 42.7), 1,501-2,000 g (OR 7.2; 95% CI 2.4, 21.4), and 2,001-2,500 g (OR 6.6; 95% CI 2.1, 21.2) as compared with breech delivery by cesarean in nulliparous women. Birth trauma was increased in VBD of newborns weighing 1,500-2,000 g (OR 3.8; 95% CI 1.4, 10.1) and 2,001-2,500 g (OR 4.5; 95% CI 2.6, 7.9) as compared to breech delivery by cesarean in nulliparous women. Birth asphyxia was increased in breech newborns weighing 2,001-2,500 g (OR 3.5; 95% CI 2.2, 5.6) delivered vaginally in nulliparous women as compared to cephalic vaginal deliveries. CONCLUSION: VBD of the preterm, LBW newborn is associated with significantly increased neonatal mortality as compared to cesarean section at similar birth weights. Birth trauma (> 1,500 g) was greater with VBD as compared to breech delivery by cesarean, and asphyxia (> 2,000 g) was greater with VBD as compared to cephalic vaginal delivery, suggesting that cesarean delivery may be a safer route of delivery for preterm breech fetuses.
Peter A Robilio; Nina M Boe; Beate Danielsen; William M Gilbert
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Journal of reproductive medicine     Volume:  52     ISSN:  0024-7758     ISO Abbreviation:  J Reprod Med     Publication Date:  2007 Jun 
Date Detail:
Created Date:  2007-08-14     Completed Date:  2007-09-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0173343     Medline TA:  J Reprod Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  473-9     Citation Subset:  IM    
Department of Obstetrics and Gynecology, University of California, Davis, and Health Information Solutions, Rocklin, California, USA.
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MeSH Terms
Birth Injuries / epidemiology,  etiology
Breech Presentation*
California / epidemiology
Cesarean Section / adverse effects,  mortality*
Cohort Studies
Delivery, Obstetric / adverse effects,  mortality*
Educational Status
Infant Mortality
Infant, Newborn
Infant, Very Low Birth Weight
Minority Groups
Premature Birth*
Retrospective Studies
Socioeconomic Factors

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