Vaginal breech delivery after 36 week of pregnancy in a selected group of pregnancy – analysis of perinatal results in years 2008–2011

Česká verzia

Authors: Lukáš Hruban ¹ ; Petr Janků ¹ ; P. Ventruba ¹; L. Oškrdalová ²; K. Skorkovská ²; Z. Hodická ¹; Veronika Ťápalová ¹ ; L. Mekiňová ¹ ; M. Šmerek ³
Authors place of work: Gynekologicko-porodnická klinika MU a FN, Brno, přednosta prof. MUDr. P. Ventruba, DrSc., MBA ¹; Neonatologické oddělení FN, Brno, primář MUDr. I. Borek ²; Katedra ekonometrie Fakulty ekonomiky a managementu, Univerzita obrany, Brno, vedoucí katedry prof. RNDr. Z. Zemánek, CSc. ³
Published in the journal: Ceska Gynekol 2014; 79(5): 343-349

Summary

Objective:
To determine intrapartum mortality, neonatal mortality and serious neonatal morbidity in selected group of planed vaginal breech deliveries after 36 week of pregnancy. Compare vaginal breech deliveries with primary cesarean deliveries.

Designe:
Retrospective study.

Settings:
Department of Obstetrics and Gynaecology, Masaryk University, University Hospital Brno; Department of neonatology, University Hospital Brno; Faculty of Economics and Management, University of Defence in Brno.

Methods:
Retrospective analysis of 1013 births of singleton pregnancies with breech position of the fetus after 36 completed week of pregnancy at University Hospital Brno in the years 2008–2011. Vaginal delivery was planed for 430 women (42.4%). Elective caesarean section was performed in 583 women (57.6%). An assessment of intrapartum and neonatal mortality and serious neonatal morbidity and incidence of umbilical artery pH < 7.00. We also evaluated non-serious neonatal morbidity. Results in the group of vaginal breech deliveries, including births completed by acute caesarean section, were compared with results in the group of elective caesarean sections.

Results:
In the group of 430 women with planned vaginal breech delivery, 347 delivered vaginally (80.7%), by acute caesarean section 83 women (19.3%). In the group of planned vaginal births, including births completed by acute caesarean section, pH < 7.00 in umbilical artery occurred in 9 cases (2.1%). In the group of elective caesarean deliveries pH < 7.00 does not occurred. Death of the fetus during labor or before 28 day after birth does not occurred. A statistically significant difference in the incidence of serious neonatal morbidity between the group of planned vaginal births and births by elective caesarean section was found in Apgar score in 5th minute < 5 (2 versus 0), peripheral nerve injury persisting at discharge (2 versus 0) and admission to the neonatal intensive care unit for longer than 24 hours (2 versus 10). When comparing all cases of serious neonatal morbidity between the two groups, the difference was not statistically significant (1.2% versus 1.9%, NS).

Conclusion:
When strict criteria are met during selection of women appropriate for vaginal breech delivery and during labor, planned vaginal breech delivery at term is save option. The incidence of severe neonatal morbidity when compared with elective caesarean section is not increased.

Keywords:
breech presentation, vaginal delivery, caesarean section, neonatal morbidity, neonatal mortality

Zdroje

1. ACOG Committee Opinion No. 340. Mode of term singleton breech delivery. Obstet Gynecol, 2001, 98, p. 1189–1190.

2. ACOG Committee Opinion No. 265. Mode of term singleton breech delivery. Obstet Gynecol, 2006, 108, p. 235–237.

3. Azria, E., Le Meaux, JP., Khoshnood, B., Alexander, S., et al. Factors associated with adverse perinatal outcomes for term breech fetuses with planned vaginal delivery. Am J Obstet Gynecol, 2012, 207(4), p. 285.

4. Binder, T., Unzeitig, V., Velebil, P. Vedení prenatální péče a porodu donošeného plodu v poloze koncem pánevním – doporučený postup. Čes Gynek, 2013, 78, s. 21–22.

5. Brodsky, MC. Optic nerve hypoplasia with posterior pituitary ectopia: male predominance and nonassociation with breech delivery. Am J Ophthalmol, 1999, 127(2), p. 238–239.

6. Collins, C., Ellaway, P., Harrington, D., Pandit, M., et al.The complications of external cephalic version: results from 805 consecutive attempts. BJOG, 2007, 114(5), p. 636–638.

7. Daviss, BA., Johnson, KC, Lalonde, AB. Evolving evidence since the Term Breech Trial: Canadian response, European dissent, and potential solutions. J Obstet Gynaecol Can, 2010, 32(3), p. 217–224.

8. Deering, S., Brown, J., Hodor, J., Satin, AJ. Simulation training and resident performance of singleton vaginal breech delivery. Obstet Gynecol, 2006, 107, p. 86–89.

9. Doyle, NM., Riggs, JW, Ramin, SM., Sosa, MA., et al. Outcomes of term vaginal breech delivery. Am J Perinatol, 2005, 22(6), p. 325–328.

10. Fujita, K., Matsuo, N., Mori, O., Koda, N., et al. The association of hypopituitarism with small pituitary, invisible pituitary stalk, type 1 Arnold-Chiari malformation, and syringomyelia in seven patients born in breech position: a further proof of birth injury theory on the pathogenesis of „idiopathic hypopituitarism“. Eur J Pediatr, 1992, 151(4), p. 266–270.

11. Goffinet, F., Carayol, M., Foidart, JM., Alexander, S., et al. PREMODA Study Group. Is planned vaginal delivery for breech presentation at term still an option? Results of an observational prospective survey in France and Belgium. Am J Obstet Gynecol, 2006, 194, p. 1002–1011.

12. Hamilton, J., Blaser, S., Daneman, D. MR Imaging in idio-pathic growth hormone deficiency. Am J Neuroradiol, 1998, 19, p. 1609–1615.

13. Hannah, ME., Hannah, WJ., Hewson, SA., Hodnett, ED., et al.Planned caesarean section versus planned vaginal birth forbreech presentation at term: a randomised multicentre trial. Term Breech Trial Collaborative Group. Lancet, 2000, 356, p. 1375–1383.

14. Hannah, ME., Hannah, WJ, Hodnett, ED., Chalmers., et al. Outcomes at 3 months after planned Caesarean vs planned vaginal delivery for breech presentation at term: the international randomized Term Breech Trial. JAMA, 2002, 287(14), p. 1822–1831.

15. Hannah, ME., Whyte, H., Hannah, WJ., Hewson, S., et al. Maternal outcomes at 2 years after planned Caesarean section versus planned vaginal birth for breech presentation at term: the international randomized Term Breech Trial. Am J Obstet Gynecol, 2004, 191(3), p. 917–927.

16. Huser, M., Belkov, I., Janků, P., Sedláková, K. Pregnancy and delivery after the mid-urethral sling surgery for stress urinary incontinence. Int J Gynecol Obstet, 2012, 119, p. 117–120.

17. Kotaska, A. Breech birth can besSafe, but is it worth the effort? J Obstet Gynaecol Can, 2009, 31(6), p. 553–554.

18. Kotaska, A., Menticoglou, S., Gagnon, R. Vaginal delivery of breech presentation. SOGC Clinical Practice Guideline No. 226, June 2009. J Obstet Gynaecol Can, 2009, 31(6), p. 557–566.

19. Lalonde, A. Vaginal breech delivery guideline: the time has come. J Obstet Gynaecol Can, 2009, 31(6), p. 483–484.

20. Lebl, J., Zemková, D. An aid for the early diagnosis of hypothalamo-hypophyseal nanism: natural growth in children with growth hormone deficiency during the first years of life. Ces Pediatr, 1990, 45(9), p. 513–517.

21. Molkenboer, JF., Vencken, PMLH., Sonnemans, LGJ., Roumen, FJME., et al. Conservative management in breech deliveries leads to similar results compared with cephalic deliveries.J Matern Fetal Neonatal Med, 2007, 20(8), p. 599–603.

22. RCOG Guideline No. 20b. The Management of Breech Presentation, December 2006.

23. Rietberg, CC., Elferink-Stinkens, PM., Visser, GH. The effect of the Term Breech Trial on medical intervention behaviour and neonatal outcome in The Netherlands: an analysis of 35,453 term breech infants. BJOG, 2005, 112, p. 205–209.

24. Taillefer, C., Dubé, J. Singleton breech at term: Two continents, two approaches. J Obstet Gynaecol Can, 2010, 32(3), p. 238–243.

25. Whyte, H., Hannah, ME., Saigal, S., Hannah, WJ., et al. Outcomes of children at 2 years after planned cesarean birth versus planned vaginal birth for breech presentation at term: the International Randomized Term Breech Trial. Am J Obstet Gynecol, 2004, 191, p. 864–871.