Influence of maternal-fetal medicine subspecialization on the frequency of trial of labor in term pregnancies with breech presentation.
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.
Blackwell
S C
SC
Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan 48201, USA. mfmboy@aol.com
Wolfe
H M
HM
Schimp
V
V
Hassan
S S
SS
Berman
S
S
Berry
S M
SM
Sorokin
Y
Y
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