Outcomes in term breech birth according to intended mode of delivery—A Swedish prospective single-center experience of a dedicated breech birth team

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Acta Obstetricia et Gynecologica Scandinavica Pub Date : 2024-08-12 DOI:10.1111/aogs.14945

Nicolas Yaouzis Olsson, Emma Debora Bartfai, Hanna Åmark, Tove Wallström

{"title":"Outcomes in term breech birth according to intended mode of delivery—A Swedish prospective single-center experience of a dedicated breech birth team","authors":"Nicolas Yaouzis Olsson, Emma Debora Bartfai, Hanna Åmark, Tove Wallström","doi":"10.1111/aogs.14945","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Introduction</h3>\n \n <p>The appropriate mode of delivery for breech babies is a topic of ongoing debate. After the publication of the <i>Term Breech Trial</i> in 2000, the proportion of breech babies delivered vaginally in Sweden rapidly dropped to 7% from 26%. In 2015, international guidelines changed to once again recommend offering vaginal breech deliveries in select cases. In 2017, a Swedish hospital established a dedicated Breech Team to provide safe vaginal breech deliveries according to the new guidelines. The aim of this study is to compare neonatal morbidity in the group planned for cesarean breech delivery with the group planned for vaginal breech delivery treated in accordance with the new guidelines. The study adds to the literature by providing insights into the consequences of reintroducing vaginal breech births in a high-resource health-care setting.</p>\n </section>\n \n <section>\n \n <h3> Material and Methods</h3>\n \n <p>A prospective observational study was conducted at Södersjukhuset's maternity ward with 1067 women who gave birth to a single breech fetus at term. Outcomes were compared between the planned vaginal and planned cesarean delivery groups using intention-to-treat analysis and multivariate analysis to control for confounders.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Out of the 1067 women, 78.9% were planned for cesarean delivery and 21.1% were planned for vaginal delivery. The planned vaginal group had a significantly greater risk for neonatal morbidity compared to the planned cesarean group (3.1% vs. 0.7%; OR 4.44, 95% CI 1.48–13.34). The risk difference remained significant after controlling for confounders.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Planned vaginal breech delivery was associated with an increased risk of neonatal mortality and short-term morbidity compared to planned cesarean breech delivery in accordance with the new guidelines. The potential risks and benefits of planned vaginal breech delivery should be carefully weighed against those of planned cesarean delivery.</p>\n </section>\n </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"103 11","pages":"2296-2305"},"PeriodicalIF":3.5000,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11502450/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Acta Obstetricia et Gynecologica Scandinavica","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/aogs.14945","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction

The appropriate mode of delivery for breech babies is a topic of ongoing debate. After the publication of the Term Breech Trial in 2000, the proportion of breech babies delivered vaginally in Sweden rapidly dropped to 7% from 26%. In 2015, international guidelines changed to once again recommend offering vaginal breech deliveries in select cases. In 2017, a Swedish hospital established a dedicated Breech Team to provide safe vaginal breech deliveries according to the new guidelines. The aim of this study is to compare neonatal morbidity in the group planned for cesarean breech delivery with the group planned for vaginal breech delivery treated in accordance with the new guidelines. The study adds to the literature by providing insights into the consequences of reintroducing vaginal breech births in a high-resource health-care setting.

Material and Methods

A prospective observational study was conducted at Södersjukhuset's maternity ward with 1067 women who gave birth to a single breech fetus at term. Outcomes were compared between the planned vaginal and planned cesarean delivery groups using intention-to-treat analysis and multivariate analysis to control for confounders.

Results

Out of the 1067 women, 78.9% were planned for cesarean delivery and 21.1% were planned for vaginal delivery. The planned vaginal group had a significantly greater risk for neonatal morbidity compared to the planned cesarean group (3.1% vs. 0.7%; OR 4.44, 95% CI 1.48–13.34). The risk difference remained significant after controlling for confounders.

Conclusions

Planned vaginal breech delivery was associated with an increased risk of neonatal mortality and short-term morbidity compared to planned cesarean breech delivery in accordance with the new guidelines. The potential risks and benefits of planned vaginal breech delivery should be carefully weighed against those of planned cesarean delivery.

Abstract Image

查看原文本刊更多论文

根据预期分娩方式的临产臀位分娩结果--瑞典前瞻性单中心臀位分娩专门小组的经验。

导言：臀位分娩的合适方式一直是一个争论不休的话题。2000 年，瑞典发布了 "胎儿臀位试验"（Term Breech Trial）后，臀位儿经阴道分娩的比例从 26% 迅速降至 7%。2015 年，国际指南再次建议在特定情况下进行阴道臀位分娩。2017 年，一家瑞典医院成立了专门的臀位分娩团队，根据新指南提供安全的阴道臀位分娩。本研究旨在比较计划剖宫产臀位分娩组和根据新指南计划阴道臀位分娩组的新生儿发病率。该研究通过对在高资源医疗保健环境中重新引入阴道臀位分娩的后果进行深入研究，为相关文献增添了新的内容：一项前瞻性观察研究在 Södersjukhuset 的产科病房进行，共收录了 1067 名足月分娩单臀位胎儿的产妇。采用意向治疗分析法和多变量分析法对计划阴道分娩组和计划剖宫产组的结果进行比较，以控制混杂因素：在1067名产妇中，78.9%计划剖宫产，21.1%计划阴道分娩。与计划剖宫产组相比，计划阴道分娩组的新生儿发病风险明显更高（3.1% 对 0.7%；OR 4.44，95% CI 1.48-13.34）。在控制了混杂因素后，风险差异仍然显著：结论：根据新指南，与计划剖宫产臀位分娩相比，计划阴道臀位分娩增加了新生儿死亡和短期发病的风险。应谨慎权衡计划性阴道臀位分娩与计划性剖宫产的潜在风险和益处。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Acta Obstetricia et Gynecologica Scandinavica 医学-妇产科学

CiteScore

8.00

自引率

4.70%

发文量

180

审稿时长

3-6 weeks

期刊介绍： Published monthly, Acta Obstetricia et Gynecologica Scandinavica is an international journal dedicated to providing the very latest information on the results of both clinical, basic and translational research work related to all aspects of women’s health from around the globe. The journal regularly publishes commentaries, reviews, and original articles on a wide variety of topics including: gynecology, pregnancy, birth, female urology, gynecologic oncology, fertility and reproductive biology.