title: Breech presentation: its predictors and consequences. An analysis of the Hungarian Tauffer Obstetric Database (1996-2011).
abstract: BACKGROUND
  Breech presentation is linked to abnormal pregnancy outcomes. However, the causality of this association is unknown. We aimed to investigate predictors of term breech presentation and pregnancy outcomes of breech presentation.
  
  
  METHODS
  Using a Hungarian registry, all term (≥ 37 weeks), singleton pregnancies with cephalic, and breech presentation in 1996-2011 were analyzed (n = 41 796). Covariates were maternal medical history and data on the present pregnancy. Multivariable logistic regression was used to investigate predictors of breech presentation and of delivery (cesarean section or other obstetrical interventions at birth) and fetal outcomes (Apgar score ≤ 7, need for perinatal intensive treatment, intrauterine death or perinatal mortality) related to breech presentation.
  
  
  RESULTS
  Breech presentation was independently associated with older maternal age, medical history (primiparity, stillbirth, spontaneous abortion, hormone treatment, and assisted reproduction), maternal morbidities (hypertension and oligohydramnios), and the fetal factors (female sex, younger gestational age at delivery, developmental abnormalities, small for gestational age, and birthweight). An adverse delivery outcome was 11.7 times (95% confidence interval 11.3-12.0) and an adverse fetal outcome was 1.39 times (95% confidence interval 1.33-1.45) more frequent in pregnancies with breech presentation compared with cephalic presentation. Further adjustment for predictors of breech presentation had no major effect on the delivery outcome, but it reduced the risk of adverse fetal outcome (odds ratio 1.18, 95% confidence interval 1.14-1.24).
  
  
  CONCLUSIONS
  Breech presentation is a marker of pathological pregnancy and is independently associated with an increased risk of gestational complications. Closer surveillance and appropriate management of pregnancies with breech presentation is warranted to prevent adverse perinatal outcomes.
authors.affiliation: Department of Gynecology and Family Planning, Istenhegyi GeneDiagnostic Center, Budapest, Hungary.
authors.forename: László
authors.identifier: http://orcid.org/0000-0002-0395-1528
authors.initials: L
authors.lastname: Zsirai
authors.affiliation: Department of Obstetrics and Gynecology, Jahn Ferenc Hospital, Budapest, Hungary.
authors.forename: György M
authors.identifier: http://orcid.org/0000-0002-1222-9713
authors.initials: GM
authors.lastname: Csákány
authors.affiliation: Department of Cardiology, Cardiology Center, Semmelweis University Faculty of Medicine, Budapest, Hungary.
authors.forename: Péter
authors.identifier: http://orcid.org/0000-0001-6859-3824
authors.initials: P
authors.lastname: Vargha
authors.affiliation: Department of Obstetrics and Gynecology, Military Hospital, Budapest, Hungary.
authors.forename: Vilmos
authors.identifier: http://orcid.org/0000-0002-8245-5310
authors.initials: V
authors.lastname: Fülöp
authors.affiliation: 1st Department of Internal Medicine, Semmelweis University Faculty of Medicine, Budapest, Hungary.|Department of Epidemiology and Public Health, University College London, London, UK.
authors.forename: Ádám G
authors.identifier: http://orcid.org/0000-0002-6234-3936
authors.initials: ÁG
authors.lastname: Tabák
mesh_terms: D000022:Abortion, Spontaneous / Q000453:epidemiology; D000328:Adult; D001034:Apgar Score; D001946:Breech Presentation / Q000453:epidemiology*; D002585:Cesarean Section / Q000706:statistics & numerical data; D000013:Congenital Abnormalities / Q000453:epidemiology; D005260:Female; D006728:Hormones / Q000627:therapeutic use; D006801:Humans; D006814:Hungary / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D015931:Intensive Care, Neonatal / Q000706:statistics & numerical data; D008423:Maternal Age; D016104:Oligohydramnios / Q000453:epidemiology; D010298:Parity; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D012042:Registries; D027724:Reproductive Techniques, Assisted; D050497:Stillbirth / Q000453:epidemiology; D055815:Young Adult
chemical_list: D006728:Hormones
keywords: Breech presentation; factors predisposing to breech presentation; gestational complications; obstetrics database; population-based study; pregnancy