title: Risk factors and outcomes in "well-selected" vaginal breech deliveries: a retrospective observational study.
abstract: OBJECTIVE
  To assess risk factors for adverse perinatal and neonatal outcomes in "well-selected" singleton vaginal breech deliveries at term.
  
  
  METHODS
  During the time span from January 2008 up to April 2015 a total of 786 singleton term breech deliveries with a planned vaginal delivery were identified in a retrospective observational study at Helsinki University Central Hospital, Finland. The study's end point was a composite of adverse perinatal and neonatal outcomes. Infants with an adverse outcome were compared to all spontaneous singleton vaginal breech deliveries with normal perinatal and neonatal outcomes. A multivariate logistic regression model was used to analyze associations between adverse neonatal outcomes and several variables. The secondary outcome was the severe morbidity rate according to the criteria of the term breech trial.
  
  
  RESULTS
  An adverse neonatal outcome was recorded for 38 (4.8%) infants. According to the study the second delivery stage lasting <40 min [adjusted odds ratio (aOR): 0.34, 95% confidence interval (95% CI): 0.15-0.79] was associated with lower odds and had a protective effect against adverse outcomes. Epidural anesthesia (aOR: 2.88, 95% CI: 1.08-7.70) was associated with higher adverse outcomes. The incidence rate of severe morbidity was 1.3% (10/787).
  
  
  CONCLUSIONS
  Adverse neonatal outcomes in well-selected breech deliveries are associated with a prolonged second delivery stage lasting >40 min and with epidural anesthesia.
authors.affiliation: Department of Obstetrics and Gynecology, Helsinki University and Helsinki University Central Hospital, Helsinki.
authors.forename: Georg
authors.initials: G
authors.lastname: Macharey
authors.affiliation: Department of Obstetrics and Gynecology, Helsinki University and Helsinki University Central Hospital, Helsinki.
authors.forename: Veli-Matti
authors.initials: VM
authors.lastname: Ulander
authors.affiliation: Department of Obstetrics and Gynecology, Helsinki University and Helsinki University Central Hospital, Helsinki.
authors.forename: Seppo
authors.initials: S
authors.lastname: Heinonen
authors.affiliation: Department of Health and Social Affairs, Fresenius University of Applied Sciences, Idstein.
authors.forename: Karel
authors.initials: K
authors.lastname: Kostev
authors.affiliation: Department of Obstetrics and Gynecology, Helsinki University and Helsinki University Central Hospital, Helsinki.
authors.forename: Mika
authors.initials: M
authors.lastname: Nuutila
authors.affiliation: Department of Obstetrics and Gynecology, Helsinki University and Helsinki University Central Hospital, Helsinki.
authors.forename: Mervi
authors.initials: M
authors.lastname: Väisänen-Tommiska
mesh_terms: D000328:Adult; D001946:Breech Presentation / Q000601:surgery*; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005387:Finland; D006801:Humans; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Breech delivery; cesarean section; neonatal morbidity; neonatal mortality; perinatal morbidity; perinatal mortality