title: Educational outcomes following breech delivery: a record-linkage study of 456947 children.
abstract: BACKGROUND
  Obstetric management of term breech infants changed dramatically following the Term Breech Trial which suggested increased serious neonatal morbidity following trial of labour. Short-term morbidity is a poor proxy of long-term neurological sequelae. We determined whether vaginal breech delivery was associated with educational outcomes.
  
  
  METHODS
  We linked three Scotland-wide administrative databases at an individual level: the ScotXed school census; Scottish Qualifications Authority (SQA) examination results; and Scottish Morbidity Record (SMR02) maternity database. The linkage provided information on singleton children, born at term, attending Scottish schools between 2006 and 2011.
  
  
  RESULTS
  Of the 456 947 eligible children, 1574 (0.3%) had vaginal breech deliveries, 12 489 (2.7%) planned caesarean section for breech presentation and 442 090 (96.9%) vaginal cephalic deliveries. The percentage of term breech infants delivered vaginally fell from 23% to 7% among children who started school in 2006 and 2011, respectively. Of children born by vaginal breech delivery, 1.5% had a low 5-min Apgar score (≤3) compared with only 0.4% of those born by either breech caesarean section [adjusted odds ratio (OR) 6.16, 95% confidence interval (CI) 4.44-8.54, p<0.001] or cephalic vaginal delivery (adjusted OR 3.84, 95% CI 2.99-4.93, p<0.001). Children born by vaginal breech delivery had lower examination attainment than those born by either planned caesarean section for breech presentation (adjusted OR 1.16, 95% CI 1.02-1.32, p=0.020) or vaginal cephalic delivery (adjusted OR 1.14, 95% CI 1.01-1.28, p=0.029).
  
  
  CONCLUSIONS
  Vaginal delivery of term breech infants was associated with lower examination attainment, as well as poorer Apgar scores, suggesting that the adverse effects are not just short-term.
authors.affiliation: Institute of Health and Wellbeing, Glasgow University, Glasgow, UK, Information Services Division, NHS National Services Scotland, Edinburgh, UK, ScotXed Unit, Scottish Government, Edinburgh, UK and Obstetrics and Gynaecology Department, Cambridge University, Cambridge, UK.
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Mackay
authors.affiliation: Institute of Health and Wellbeing, Glasgow University, Glasgow, UK, Information Services Division, NHS National Services Scotland, Edinburgh, UK, ScotXed Unit, Scottish Government, Edinburgh, UK and Obstetrics and Gynaecology Department, Cambridge University, Cambridge, UK.
authors.forename: Rachael
authors.initials: R
authors.lastname: Wood
authors.affiliation: Institute of Health and Wellbeing, Glasgow University, Glasgow, UK, Information Services Division, NHS National Services Scotland, Edinburgh, UK, ScotXed Unit, Scottish Government, Edinburgh, UK and Obstetrics and Gynaecology Department, Cambridge University, Cambridge, UK.
authors.forename: Albert
authors.initials: A
authors.lastname: King
authors.affiliation: Institute of Health and Wellbeing, Glasgow University, Glasgow, UK, Information Services Division, NHS National Services Scotland, Edinburgh, UK, ScotXed Unit, Scottish Government, Edinburgh, UK and Obstetrics and Gynaecology Department, Cambridge University, Cambridge, UK.
authors.forename: David N
authors.initials: DN
authors.lastname: Clark
authors.affiliation: Institute of Health and Wellbeing, Glasgow University, Glasgow, UK, Information Services Division, NHS National Services Scotland, Edinburgh, UK, ScotXed Unit, Scottish Government, Edinburgh, UK and Obstetrics and Gynaecology Department, Cambridge University, Cambridge, UK.
authors.forename: Sally-Ann
authors.initials: SA
authors.lastname: Cooper
authors.affiliation: Institute of Health and Wellbeing, Glasgow University, Glasgow, UK, Information Services Division, NHS National Services Scotland, Edinburgh, UK, ScotXed Unit, Scottish Government, Edinburgh, UK and Obstetrics and Gynaecology Department, Cambridge University, Cambridge, UK.
authors.forename: Gordon C S
authors.initials: GC
authors.lastname: Smith
authors.affiliation: Institute of Health and Wellbeing, Glasgow University, Glasgow, UK, Information Services Division, NHS National Services Scotland, Edinburgh, UK, ScotXed Unit, Scottish Government, Edinburgh, UK and Obstetrics and Gynaecology Department, Cambridge University, Cambridge, UK Jill.pell@glasgow.ac.uk.
authors.forename: Jill P
authors.initials: JP
authors.lastname: Pell
mesh_terms: D000293:Adolescent; D001034:Apgar Score; D001946:Breech Presentation / Q000453:epidemiology*; D002585:Cesarean Section; D002648:Child; D002657:Child Development; D002675:Child, Preschool; D036861:Delivery, Obstetric / Q000009:adverse effects* / Q000379:methods*; D004522:Educational Status; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007360:Intelligence; D008297:Male; D009017:Morbidity; D011247:Pregnancy; D012189:Retrospective Studies; D012606:Scotland / Q000453:epidemiology
keywords: Apgar score; breech presentation; educational status; intellectual disability