Evidence-based changes in term breech delivery practice in Sweden.
OBJECTIVE
Medical documentation on term breech delivery (TBD) advocates planned abdominal delivery based on evidence. The aim of the present study was to describe a change in TBD practice in Sweden following evidence-based documentation arguing in favor of TBD by cesarean section (CS).


METHODS
The study was a population-based observational study based on data from the Swedish Medical Birth Register. Eligible subjects were all mothers with singleton children in term breech (TB) presentation born between 1999 and 2001 at > 36 weeks' gestational age. Data were processed, and subjects were subdivided into groups, according to mode of delivery.


RESULTS
The CS rate increased from 75.3% in 1999 to 86.0% in 2001, due to an increase in planned abdominal deliveries. The change towards abdominal deliveries was more obvious for hospitals with fewer deliveries. While today, an increasing number of hospitals clearly have a non-selective CS policy, with a > 95% CS rate, others still deliver 30% of TB babies vaginally.


CONCLUSIONS
In conclusion, the evidence-based recommendation for TBD has so far had considerable impact on Swedish obstetric practice.
Alexandersson
Olof
O
Obstetrics and Gynecology, Department of Clinical Science, Umea University, Sweden.
Bixo
Marie
M
Högberg
Ulf
U
D000328:Adult; D001946:Breech Presentation; D036861:Delivery, Obstetric / Q000379:methods / Q000706:statistics & numerical data*; D019317:Evidence-Based Medicine; D005260:Female; D006276:Health Facility Size; D006801:Humans; D007231:Infant, Newborn; D009774:Obstetrics / Q000639:trends; D010043:Outcome and Process Assessment, Health Care; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012042:Registries; D013548:Sweden / Q000453:epidemiology