title: Preterm Breech Presentation: A Comparison of Intended Vaginal and Intended Cesarean Delivery.
abstract: OBJECTIVE
  To study the association of the intended mode of delivery and perinatal morbidity and mortality among breech fetuses who are delivered preterm.
  
  
  METHODS
  We conducted a nationwide cohort study of women with a singleton pregnancy in breech presentation who delivered preterm (26 0/7-36 6/7 weeks of gestation) in the years 2000-2011. We compared perinatal outcomes according to the intended and actual mode of delivery using multivariate logistic regression analysis. We performed subgroup analyses of gestational age and parity.
  
  
  RESULTS
  We studied 8,356 women with a preterm singleton breech delivery. Intended cesarean delivery (n=1,935) was not associated with a significant reduction in perinatal mortality compared with intended vaginal delivery (n=6,421) (1.3% compared with 1.5%; adjusted odds ratio [OR] 0.97, 95% confidence interval [CI] 0.60-1.57). However, the composite of perinatal mortality and morbidity was significantly reduced in the intended cesarean delivery group (8.7% compared with 10.4%; adjusted OR 0.77, 95% CI 0.63-0.93). In the subgroup of women delivering at 28-32 weeks of gestation, intended cesarean delivery was associated with a 1.7% risk of perinatal mortality compared with 4.1% with intended vaginal delivery (adjusted OR 0.27, 95% CI 0.10-0.77) and significantly reduced composite mortality and severe morbidity, 5.9% compared with 10.1% (adjusted OR 0.37, 95% CI 0.20-0.68).
  
  
  CONCLUSIONS
  In women delivering a preterm breech fetus, cesarean delivery is associated with reduced perinatal mortality and morbidity.
  
  
  METHODS
  II.
authors.affiliation: Department of Obstetrics and Gynecology, ZGT, Almelo, and the Departments of Obstetrics and Gynecology and Medical Informatics, Amsterdam Medical Centre, Amsterdam, the Netherlands; and the Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia.
authors.forename: Lester
authors.initials: L
authors.lastname: Bergenhenegouwen
authors.forename: Floortje
authors.initials: F
authors.lastname: Vlemmix
authors.forename: Sabine
authors.initials: S
authors.lastname: Ensing
authors.forename: Jelle
authors.initials: J
authors.lastname: Schaaf
authors.forename: Joris
authors.initials: J
authors.lastname: van der Post
authors.forename: Ameen
authors.initials: A
authors.lastname: Abu-Hanna
authors.forename: Anita C J
authors.initials: ACJ
authors.lastname: Ravelli
authors.forename: Ben W
authors.initials: BW
authors.lastname: Mol
authors.forename: Marjolein
authors.initials: M
authors.lastname: Kok
mesh_terms: D000328:Adult; D001946:Breech Presentation; D002585:Cesarean Section; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000453:epidemiology / Q000209:etiology*; D033182:Intention; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009426:Netherlands / Q000453:epidemiology; D054238:Perinatal Mortality; D011247:Pregnancy; D047928:Premature Birth; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors