Outcomes Among Vaginal Versus Caesarean Periviable Breech Deliveries: A Propensity Score-Matched Study

Area of Science:

• Perinatal Medicine
• Neonatal Outcomes
• Maternal Health

Background:

• Breech, singleton deliveries at 22 0/7 to 25 6/7 weeks gestation present unique challenges.
• The optimal delivery mode (vaginal vs. caesarean) for these periviable infants remains a critical clinical question.

Purpose of the Study:

• To evaluate the association between vaginal and caesarean birth and neonatal and maternal outcomes.
• To compare risks for breech, singleton deliveries at extremely early gestational ages (22 0/7 to 25 6/7 weeks).

Main Methods:

• Retrospective cohort study of US hospital births (2016-2021) for non-anomalous, singleton, breech live births.
• Propensity score matching (1:2 ratio) to balance baseline characteristics between vaginal and caesarean delivery groups.
• Analysis of composite adverse neonatal and maternal outcomes, including mortality rates.

Main Results:

• Vaginal breech births (34.0%) occurred at an earlier median gestational age compared to caesarean births.
• Higher rates of composite adverse neonatal outcomes (99.0% vs. 96.8%) and neonatal mortality (72.6% vs. 36.2%) were observed with vaginal breech delivery.
• Lower rates of composite adverse maternal outcomes were associated with vaginal breech delivery (1.6% vs. 3.1%).

Conclusions:

• Vaginal breech birth in the periviable period (22-25 weeks) is associated with increased neonatal adverse outcomes and mortality.
• Conversely, vaginal breech birth shows a reduced risk of adverse maternal outcomes.
• The findings underscore the complex risk-benefit balance for delivery mode in extremely preterm breech infants.