Comparative analysis of maternal and neonatal outcomes in cases of vaginal breech births versus cases of vaginal cephalic births: a retrospective cohort study

Purpose

This study examines whether the perinatal mortality rates (up to 7 days postpartum) of successful vaginal breech birth (VBB) align with those of vaginal cephalic birth (VCB) under the current practice of risk stratification and promotion of VBB in Germany. This study excludes births that did not result in vaginal breech birth, i.e., cases where a vaginal birth was attempted but discontinued.

Methods

A retrospective cohort analysis of the 2021 German population dataset compared 1435 VBBs to 422,019 VCBs. Maternal and neonatal short-term outcomes were analyzed using Chi-squared and Mann–Whitney U tests.

Results

Main outcome: No significant difference in perinatal mortality rates between VBB and VCB. Other neonatal outcomes: Mean arterial blood gas levels and mean APGAR levels were lower in the breech group. The need for resuscitation measures and transfers to the pediatric hospital were increased. Maternal outcomes: Births in the breech group received labor augmentation more frequently and had higher rates of episiotomies. They had lower rates of perineal tears and postpartum complications. The rates of hysterectomies and increased postpartum hemorrhage did not differ significantly.

Conclusion

With thorough risk stratification and interdisciplinary expert management, perinatal mortality rates (up to 7 days postpartum) of VBBs align with VCBs. However, higher neonatal intervention rates in VBB highlight the need to ensure adequate resources and preparedness for postnatal support.