Pregnancy outcomes by mode of delivery among term breech births: Swedish experience 1987-1993

To study the influence of mode of delivery on infant mortality, neonatal morbidity, and maternal morbidity in pregnancies with nonmalformed term singleton infants presented in breech.

We studied all nonmalformed live-born singleton infants, delivered at term (at 37 weeks or later) in breech position in Sweden between 1987 and 1993 (n = 15,818). The pregnancy outcomes analyzed were neonatal and infant mortality, low Apgar score (less than 7) at 5 minutes, birth injury, and neonatal convulsions. Severe perineal or vaginal lacerations, wound rupture, infections, and thrombosis were used as measures of maternal morbidity. Logistic regression analysis was used to determine risks of infant mortality and morbidity, after adjusting for a number of potential confounders.

Compared with infants delivered by elective cesarean, infants delivered vaginally were at significantly higher risk for infant mortality (odds ratio [OR] 2.5). Infants delivered vaginally were at increased risk for birth injury (OR 12.2), and infants delivered by emergency cesarean were at increased risk for neonatal convulsions (OR 4.1). Infants delivered vaginally or by emergency cesarean were at increased risk for a low Apgar score at 5 minutes. Maternal morbidity was highest among women who delivered by emergency cesarean (2.8%), whereas lower rates were obtained among women who delivered vaginally and those who delivered by elective cesarean (1.8 and 1.7%, respectively).

Vaginal delivery of term infants presented in breech is associated with higher risks of neonatal mortality and morbidity compared with delivery by elective cesarean. We conclude that term singleton infants presented in breech would benefit from an elective cesarean delivery.