title: Neonatal outcome of singleton term breech deliveries in Norway from 1991 to 2011.
abstract: BACKGROUND
  The objective of this study was to examine the association between planned mode of delivery and neonatal outcomes in breech deliveries.
  
  
  METHODS
  In this retrospective cohort study we studied singleton term breech deliveries in Norway from 1991 to 2011 (n = 30 861) using the Medical Birth Registry of Norway. We compared planned vaginal delivery with planned cesarean delivery across two time periods: from 1 January 1991 to 31 October 2000 (first period) and from 1 November 2000 to 31 December 2011 (second period). Intrapartum and neonatal deaths were validated against source data in medical records, autopsy reports, and other relevant documents. The main outcome measures were intrapartum and neonatal mortality within the first 28 days of life, 5-min Apgar-scores <7 and <4, neonatal intensive care unit stays ≥4 days, respiratory morbidity, and intracranial bleeding disorders.
  
  
  RESULTS
  Rate of planned cesarean delivery increased from 34.4 to 51.3% over the period. Simultaneously, early neonatal mortality rate (0-6 days) declined (from 0.10% to 0.04%, p = 0.04). During the second period, 30.7% of term breech presentations were delivered vaginally. Eight deaths in the planned vaginal vs. four in the planned cesarean groups were observed (OR 2.11 95% CI 0.64-7.01). Neonatal morbidity outcomes were significantly worse in planned vaginal deliveries compared with planned cesarean deliveries in both periods.
  
  
  CONCLUSIONS
  Overall intrapartum and neonatal mortality decreased during the entire period. Higher mortality in planned vaginal delivery relative to planned cesarean delivery in the second period was not statistically significant. However, neonatal morbidity was significantly higher in planned vaginal than planned cesarean deliveries in both periods. This warrants continuous surveillance of breech deliveries.
authors.affiliation: Department of Obstetrics and Gynecology, Sorlandet Hospital HF, Kristiansand, Norway.
authors.forename: Ingvild
authors.initials: I
authors.lastname: Vistad
authors.affiliation: Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.|Medical Birth Registry of Norway, Norwegian Institute of Public Health, Bergen, Norway.
authors.forename: Kari
authors.initials: K
authors.lastname: Klungsøyr
authors.affiliation: Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway.|Department of Clinical Medicine, University of Bergen, Bergen, Norway.
authors.forename: Susanne
authors.initials: S
authors.lastname: Albrechtsen
authors.affiliation: Faculty of Health Sciences, Department of Community Medicine, Research Group Epidemiology of Chronic Diseases, UiT, the Arctic University of Norway, Tromsø, Norway.
authors.forename: Finn E
authors.initials: FE
authors.lastname: Skjeldestad
mesh_terms: D000328:Adult; D001034:Apgar Score; D001946:Breech Presentation / Q000401:mortality* / Q000628:therapy; D003422:Critical Care; D036861:Delivery, Obstetric; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D007902:Length of Stay; D008297:Male; D009664:Norway / Q000453:epidemiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D012042:Registries; D012189:Retrospective Studies; D055815:Young Adult
keywords: Breech presentation; birth registry; mode of delivery; neonatal morbidity; neonatal mortality; vaginal breech delivery