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

Czech version

Authors: Lukáš Hruban ¹; Petr Janků ¹; P. Ventruba ¹; L. Oškrdalová ²; K. Skorkovská ²; Z. Hodická ¹; V. Ťápalová ¹; L. Mekiňová ¹; M. Šmerek ³
Authors‘ workplace: 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: Ceska Gynekol 2014; 79(5): 343-349

Overview

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

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