title: Influence of maternal-fetal medicine subspecialization on the frequency of trial of labor in term pregnancies with breech presentation.
abstract: OBJECTIVE
  To investigate the role of subspecialization in maternal-fetal medicine (MFM) on the frequency of a trial of labor in term pregnancies with breech presentation.
  
  
  METHODS
  We conducted a retrospective study of 332 singleton pregnancies > or =37 weeks with nonfootling breech presentation that delivered over a 6-year period (1994-1998) at a university-based, tertiary care hospital. Patients were divided into two groups based on whether the delivery was attended by an MFM or non-MFM obstetrician-gynecologist. Demographic and clinical data were compared between groups and outcome variables included whether the patient had an attempt at vaginal delivery, cesarean delivery after a labor attempt, or vaginal breech delivery.
  
  
  RESULTS
  The frequency of labor attempt (OR 1.4, 95% CI 0.9-2.3), vaginal breech success rate (OR 0.6, 95% CI 0.3-1.5), and overall cesarean rates (OR 0.9, 95% CI 0.5-1.7) were similar between groups. Using discriminant function analysis, only nulliparity (R2 = 1.6%, F = 6.0, P = 0.005) and birthweight (R2 = 2.0% F = 6.4, P = 0.01) were associated with trial of vaginal delivery.
  
  
  CONCLUSIONS
  Subspecialization in MFM had no impact on the frequency of trial of labor in the term pregnancy with a breech presentation.
authors.affiliation: Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan 48201, USA. mfmboy@aol.com
authors.forename: S C
authors.initials: SC
authors.lastname: Blackwell
authors.forename: H M
authors.initials: HM
authors.lastname: Wolfe
authors.forename: V
authors.initials: V
authors.lastname: Schimp
authors.forename: S S
authors.initials: SS
authors.lastname: Hassan
authors.forename: S
authors.initials: S
authors.lastname: Berman
authors.forename: S M
authors.initials: SM
authors.lastname: Berry
authors.forename: Y
authors.initials: Y
authors.lastname: Sorokin
mesh_terms: D000328:Adult; D001946:Breech Presentation; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008511:Medicine; D008824:Michigan; D009774:Obstetrics; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D013038:Specialization; D014219:Trial of Labor