Term breech delivery in Sweden: mortality relative to fetal presentation and planned mode of delivery

Authors

  • Andreas Herbst

    Corresponding author
    1. The Swedish Collaborative Breech Study Group*, Perinatal-ARG (Perinatal Working Group Swedish Society of Obstetrics and Gynecology)
      †Andreas Herbst
      Department of Obstetrics and Gynecology
      Lund University Hospital
      S-221 85 Lund
      Sweden
      e-mail: Andreas.Herbst@med.lu.se
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  • *

    Elisabeth Almström, Carina Bejlum, Per Buchhave, Jesper Clausen, Lars Dahle, Inga Froding, Andreas Herbst, Eva Itzel, Bo Jacobsson, Karin Källén, Jan Laurin, Jan Leyon, Lisa Lindholm-Jansson, Anna Lindqvist, Ann-Marie Lindström, Per Olofsson, Karin Pettersson, Håkan Rydhström, Håkan Stale, Jan Söderlund, Bengt Walles, Ulla-Britt Wennerholm, Magnus Westgren, Kerstin Wolff.

    Steering Committee: Andreas Herbst (Chairman), Karin Källén (Secretary), Per Olofsson, Håkan Rydhström, Håkan Stale.

    Study Design: The Swedish Collaborative Breech Study Group.

    Data Collection: Karin Källén, Petra Otterblad Olausson (The National Board of Health and Welfare, Stockholm).

    Data Evaluation and Analyses: The Swedish Collaborative Breech Study Group.

    Data Monitoring and Statistical Analyses: Karin Källén.

    Manuscript: Per Olofsson, Andreas Herbst, Karin Källén.

†Andreas Herbst
Department of Obstetrics and Gynecology
Lund University Hospital
S-221 85 Lund
Sweden
e-mail: Andreas.Herbst@med.lu.se

Abstract

Objectives.  To compare perinatal and infant mortality in breech and cephalic presentations and between planned vaginal and cesarean section (CS) breech deliveries in Sweden.

Methods.  The study comprised two parts. Study A is a national cohort study for the period 1991–2001, including 22 549 breech presentations and 875 249 cephalic presentations born at ≥38 completed weeks. Study B is a case–control study, including all 164 breech deliveries with perinatal or 1-year infant death (during 1991–1999 in Sweden) and controls.

Results.  Study A: Among non-malformed infants, the total mortality rate was 0.46% in breech and 0.28% in cephalic presentations [adjusted odds ratio (OR) 1.6; 95% confidence interval 1.3–1.9]. Non-malformed breech babies were at an increased risk of antenatal death (breech versus cephalic hazard ratio: 2.7, 2.1–3.6). The infant mortality among non-malformed breech deliveries was higher in vaginal birth than in delivery by CS before labor (OR 2.5, 1.2–5.3). The perinatal + infant mortality among non-malformed breech babies was higher at delivery after 39 completed weeks than at CS delivery at 38 weeks (0.53% versus 0.14%; OR 3.5, 1.9–6.4). The estimated needed number of CS to avoid one death was 400. Study B: In breech presentations without malformations, OR for perinatal or infant death was 3.1 (1.7–5.8) at planned vaginal delivery compared with planned CS delivery, and when breech presentations not diagnosed at 37 gestational weeks were excluded, OR was 3.7 (1.6–9.2).

Conclusions.  These large population-based and case-control studies both show a significant reduction of perinatal and infant mortality with planned CS in term breech pregnancy.

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