Optimal Mode of Delivery for Individuals With Low-Risk Term Breech Presentation.

IF 4.7 2区 医学 Q1 OBSTETRICS & GYNECOLOGY
Ruchira Sharma, Emily B Rosenfeld, Cande V Ananth
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引用次数: 0

Abstract

Objective: To evaluate the risks of neonatal and maternal adverse outcomes in individuals with low-risk, singleton, term breech presentation associated with vaginal compared with cesarean delivery in a contemporary cohort in the United States.

Methods: We conducted a propensity score analysis to evaluate adverse neonatal and maternal outcomes associated with mode of delivery among individuals with breech presentation at term. We used U.S. vital statistics data, which included information on all live births from 2015 to 2020. The eligible cohort was restricted to individuals who delivered a liveborn singleton, nonanomalous neonate at term. The treatment was vaginal or cesarean delivery. Composite neonatal and maternal outcomes were examined using a propensity score analysis to create groups based on mode of delivery with a 5-to-1 match of cesarean to vaginal deliveries. The composite neonatal outcome included neonatal mortality, 5-minute Apgar score less than 4, seizures or serious neurologic dysfunction, neonatal intensive care unit admission, or assisted ventilation 6 hours or longer. The composite maternal outcome included uterine rupture, maternal transfusion, intensive care unit admission, unplanned hysterectomy, or perineal lacerations.

Results: Of 23,118,953 singleton births, 375,500 term, nonanomalous, breech live births were identified. Of these, 5.1% (95% CI, 5.0-5.2; n=19,256) were vaginal deliveries. After propensity score matching, the final cohort comprised 96,095 patients, including 17,558 vaginal deliveries and 78,537 cesarean deliveries. The risks of the composite adverse neonatal outcome were 7.2% in the vaginal delivery group, compared with 6.3% in the cesarean delivery group (risk difference [RD] 1.0; 95% CI, 0.9-1.2; doubly robust odds ratio 1.14; 95% CI, 1.06-1.22). The primary contributor to neonatal morbidity within the vaginal breech cohort was 5-minute Apgar score less than 4 (RD 1.6; 95% CI, 1.4-1.9). Other neonatal outcomes were not different. Neonatal mortality rates were 0.4% (n=67) for vaginal births and 0.1% (n=102) for cesarean births (RD 0.3; 95% CI, 0.2-0.4). The risk of the composite adverse maternal outcome (excluding perineal lacerations) was 0.3% for vaginal births and 0.5% for cesarean breech births (RD -0.4, 95% CI, -0.5 to -0.3).

Conclusion: Although term vaginal breech delivery was associated with slightly higher odds of the composite adverse neonatal outcome compared with cesarean delivery, the absolute risk remains low. Short-term maternal outcomes were better for individuals who underwent vaginal delivery compared with cesarean delivery, after exclusion of perineal lacerations.

低风险臀位分娩个体的最佳分娩方式。
目的:在美国当代队列中,评估低风险、单胎、足月臀位阴道分娩与剖宫产分娩相关的新生儿和产妇不良结局的风险。方法:我们进行了倾向性评分分析,以评估与足月臀位分娩方式相关的新生儿和产妇不良结局。我们使用了美国生命统计数据,其中包括2015年至2020年所有活产婴儿的信息。符合条件的队列仅限于足月分娩活产单胎、无异常新生儿的个体。治疗方法是阴道分娩或剖宫产。使用倾向性评分分析对新生儿和产妇的综合结局进行检查,根据分娩方式创建分组,剖宫产与阴道分娩的比例为5:1。新生儿综合结局包括新生儿死亡率、5分钟Apgar评分小于4分、癫痫发作或严重神经功能障碍、新生儿入住重症监护病房或辅助通气6小时或更长时间。复合产妇结局包括子宫破裂、产妇输血、重症监护病房入院、计划外子宫切除术或会阴撕裂伤。结果:在23,118,953例单胎分娩中,确定了375,500例足月,非异常,臀位活产。其中,5.1% (95% CI, 5.0-5.2;N = 19256)为阴道分娩。经过倾向评分匹配后,最终队列包括96,095例患者,其中阴道分娩17,558例,剖宫产78,537例。阴道分娩组新生儿复合不良结局发生风险为7.2%,剖宫产组为6.3%(风险差[RD] 1.0;95% ci, 0.9-1.2;双稳健优势比1.14;95% ci, 1.06-1.22)。在阴道臀位队列中,新生儿发病率的主要因素是5分钟Apgar评分小于4 (RD 1.6;95% ci, 1.4-1.9)。其他新生儿结局没有差异。阴道分娩的新生儿死亡率为0.4% (n=67),剖宫产的新生儿死亡率为0.1% (n=102) (RD 0.3;95% ci, 0.2-0.4)。阴道分娩的综合不良产妇结局(不包括会阴撕裂)风险为0.3%,剖宫产为0.5% (RD -0.4, 95% CI, -0.5至-0.3)。结论:虽然足月阴道臀位分娩与剖宫产相比,复合新生儿不良结局的发生率略高,但绝对风险仍然很低。在排除会阴撕裂伤后,阴道分娩比剖宫产的短期产妇结局更好。
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来源期刊
Obstetrics and gynecology
Obstetrics and gynecology 医学-妇产科学
CiteScore
11.10
自引率
4.20%
发文量
867
审稿时长
1 months
期刊介绍: "Obstetrics & Gynecology," affectionately known as "The Green Journal," is the official publication of the American College of Obstetricians and Gynecologists (ACOG). Since its inception in 1953, the journal has been dedicated to advancing the clinical practice of obstetrics and gynecology, as well as related fields. The journal's mission is to promote excellence in these areas by publishing a diverse range of articles that cover translational and clinical topics. "Obstetrics & Gynecology" provides a platform for the dissemination of evidence-based research, clinical guidelines, and expert opinions that are essential for the continuous improvement of women's health care. The journal's content is designed to inform and educate obstetricians, gynecologists, and other healthcare professionals, ensuring that they stay abreast of the latest developments and best practices in their field.
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