Subsequent pregnancy outcome after preterm breech delivery, a population based cohort study

Area of Science:

• Obstetrics and Gynecology
• Perinatal Medicine
• Reproductive Health

Background:

• Preterm breech presentation in pregnancy poses delivery challenges.
• Mode of delivery decisions for preterm breech births impact maternal and neonatal outcomes.
• The effect on subsequent pregnancies requires further investigation.

Purpose of the Study:

• To evaluate the impact of delivery mode in women with preterm breech presentation on outcomes of their subsequent pregnancy.
• To compare planned cesarean section versus planned vaginal delivery for perinatal outcomes in both the index and subsequent pregnancies.

Main Methods:

• Nationwide population-based cohort study in the Netherlands (1999-2007).
• Inclusion of women with a preterm breech delivery and a subsequent delivery.
• Comparison of planned cesarean section versus planned vaginal delivery for perinatal outcomes.

Main Results:

• 1543 women were identified; 17% had a planned cesarean section and 83% had a planned vaginal delivery in the first pregnancy.
• In the subsequent pregnancy, perinatal mortality was 1.1% for planned cesarean and 0.5% for planned vaginal delivery (aOR 1.8; 95% CI 0.31-10.1).
• Composite adverse neonatal outcome was 2.3% for planned cesarean versus 1.5% for planned vaginal delivery (aOR 1.5; 95% CI 0.55-4.2).

Conclusions:

• Planned cesarean section in women with preterm breech delivery does not reduce perinatal mortality or morbidity in the subsequent pregnancy.
• Maternal morbidity rates were also not reduced by planned cesarean section over two pregnancies.
• Findings suggest similar overall risks for planned cesarean versus planned vaginal delivery in this cohort.