Breech Presentation: Vaginal Versus Cesarean Delivery, Which Intervention Leads to the Best Outcomes?

Authors

  • Andreia Fonseca Departamento de Obstetrícia e Ginecologia. Hospital de Santa Maria. Centro Hospital Lisboa Norte. Lisboa. Portugal.
  • Rita Silva Departamento de Obstetrícia e Ginecologia. Hospital de Santa Maria. Centro Hospital Lisboa Norte. Lisboa. Portugal.
  • Inês Rato Departamento de Obstetrícia e Ginecologia. Hospital de Santa Maria. Centro Hospital Lisboa Norte. Lisboa. Portugal.
  • Ana Raquel Neves Maternidade Bissaya Barreto. Centro Hospitalar Universitário de Coimbra. Coimbra. Portugal.
  • Carla Peixoto Departamento de Obstetrícia e Ginecologia. Centro Hospitalar de S. João. Porto. Portugal.
  • Zita Ferraz Maternidade Daniel de Matos. Centro Hospitalar Universitário de Coimbra. Coimbra. Portugal.
  • Inês Ramalho Maternidade Daniel de Matos. Centro Hospitalar Universitário de Coimbra. Coimbra. Portugal.
  • Ana Carocha Maternidade Alfredo da Costa. Centro Hospitalar Lisboa Central. Lisboa. Portugal.
  • Nisa Félix Maternidade Alfredo da Costa. Centro Hospitalar Lisboa Central. Lisboa. Portugal.
  • Sandra Valdoleiros Maternidade Alfredo da Costa. Centro Hospitalar Lisboa Central. Lisboa. Portugal.
  • Ana Galvão Maternidade Júlio Dinis. Centro Materno-Infantil do Norte. Centro Hospitalar do Porto. Porto. Portugal.
  • Daniela Gonçalves Maternidade Júlio Dinis. Centro Materno-Infantil do Norte. Centro Hospitalar do Porto. Porto. Portugal.
  • Joana Curado Departamento de Obstetrícia e Ginecologia. Hospital Garcia de Orta. Almada. Portugal.
  • Maria João Palma Departamento de Obstetrícia e Ginecologia. Hospital Garcia de Orta. Almada. Portugal.
  • Isabel Lobo Antunes Departamento de Obstetrícia e Ginecologia. Hospital Garcia de Orta. Almada. Portugal.
  • Nuno Clode Departamento de Obstetrícia e Ginecologia. Hospital de Santa Maria. Centro Hospital Lisboa Norte. Lisboa. Portugal.
  • Luís Mendes Graça Departamento de Obstetrícia e Ginecologia. Hospital de Santa Maria. Centro Hospital Lisboa Norte. Lisboa. Portugal.

DOI:

https://doi.org/10.20344/amp.7920

Keywords:

Breech Presentation, Cesarean Section, Delivery, Obstetric

Abstract

Introduction: The best route of delivery for the term breech fetus is still controversial. We aim to compare maternal and neonatal outcomes between vaginal and cesarean term breech deliveries.
Material and Methods: Multicentric retrospective cohort study of singleton term breech fetuses delivered vaginally or by elective cesarean section from January 2012 - October 2014. Primary outcomes were maternal and neonatal morbidity or mortality.
Results: Sixty five breech fetuses delivered vaginally were compared to 1262 delivered by elective cesarean. Nulliparous women were more common in the elective cesarean group (69.3% vs 24.6%; p < 0.0001). Gestational age at birth was significantly lower in the vaginal delivery group (38 ± 1 weeks vs 39 ± 0.8 weeks; p = 0.0029) as was birth weight (2928 ± 48.4 g vs 3168 ± 11.3 g; p < 0.0001). Apgar scores below seven on the first and fifth minutes were more likely in the vaginal delivery group (1st minute: 18.5% vs 5.9%; p = 0.0006; OR 3.6 [1.9 - 7.0]; 5th minute: 3.1% vs 0.2%; p = 0.0133; OR 20.0 [2.8 - 144.4]), as was fetal trauma (3.1% vs 0.3%: p = 0.031; OR 9.9 [1.8-55.6]). Neither group had cases of fetal acidemia. Admission to the Neonatal Intensive Care Unit, maternal postpartum hemorrhage and the incidence of other obstetric complications were similar between groups.
Discussion: Although vaginal breech delivery was associated with lower Apgar scores and higher incidence of fetal trauma, overall rates of such events were low. Admission to the neonatal intensive care unit and maternal outcomes were similar.
Conclusion: Both delivery routes seem equally valid, neither posing high maternal or neonatal complications’ incidence.

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Published

2017-06-30

How to Cite

1.
Fonseca A, Silva R, Rato I, Neves AR, Peixoto C, Ferraz Z, Ramalho I, Carocha A, Félix N, Valdoleiros S, Galvão A, Gonçalves D, Curado J, Palma MJ, Antunes IL, Clode N, Graça LM. Breech Presentation: Vaginal Versus Cesarean Delivery, Which Intervention Leads to the Best Outcomes?. Acta Med Port [Internet]. 2017 Jun. 30 [cited 2024 May 28];30(6):479-84. Available from: https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/7920

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Original