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Reproductive career after breech presentation: subsequent pregnancy rates, interpregnancy interval, and recurrence
S Albrechtsen1, S Rasmussen, K Dalaker
1Medical Birth Registry of Norway, University of Bergen, and the Department of Obstetrics and Gynecology, Haukeland University Hospital.
Objective:
To assess subsequent pregnancy rates and recurrence of breech, as well as interpregnancy interval after a breech presentation.
Methods:
We conducted a national population registry-based study using data from 1967 to 1994, with maternal record linkage of sibships, comprising the first to the fourth birth of a mother.
Results:
The subsequent pregnancy rate after a surviving breech birth was lower than after a surviving nonbreech birth. Women with two births, of which one was a perinatal loss, had a higher subsequent pregnancy rate, compared with those who had surviving infants. The subsequent pregnancy rate was lower after a cesarean delivery irrespective of presentation. The interpregnancy interval was shorter if the previous infant died, whereas presentation did not influence the interval. The adjusted odds ratio of recurrence of breech increased from 4.32 (95% confidence interval [CI] 4.08, 4.59) after one previous breech delivery to 28.1 (95% CI 12.2, 64.8) after three.
Conclusion:
Breech and cesarean delivery lowered the subsequent pregnancy rate, probably because of the women's decision not to reproduce. Thus, preconceptional counseling with information, support, and reassurance regarding future pregnancies and deliveries might reduce the discouraging effect. A high odds ratio of recurrence of breech suggests effects of recurring specific causal factors of either genetic or more permanent environmental origin.