title: Outcomes of breech birth by mode of delivery: a population linkage study.
abstract: BACKGROUND
  Trial evidence supports a policy of caesarean section for singleton breech presentations at term, but vaginal breech birth is considered a safe option for selected women.
  
  
  OBJECTIVE
  To provide recent Australian data on outcomes associated with intended mode of delivery for term breech singletons in women who meet conservative eligibility criteria for vaginal breech birth.
  
  
  METHODS
  Birth and hospital records from 2009 to 2012 in New South Wales were used to identify women with nonanomalous pregnancies who would be considered eligible for vaginal breech birth. Intended mode of delivery was inferred from labour onset and management.
  
  
  RESULTS
  Of 10 133 women with term breech singleton pregnancies, 5197 (51.3%) were classified as eligible for vaginal breech delivery. Of these, 6.8% intended vaginal breech birth, 76.4% planned caesarean section and intention could not be determined for 16.8%. Women intending vaginal delivery had higher rates of neonatal morbidity (6.0% vs 2.1%), neonatal birth trauma (7.4% vs 0.9%), Apgar <4 at one minute (10.5% vs 1.1%), Apgar <7 at five minutes (4.3% vs 0.5%) and neonatal intensive care unit/special care nursery admissions (16.2% vs 6.6%) than those planning caesarean section. Increased perinatal risks remained after adjustment for maternal characteristics. Severe maternal morbidity (1.4% vs 0.7%) and post-partum readmission (4.6% vs 4.0%) were higher in the intended vaginal compared to planned caesarean births, but these differences were not statistically significant.
  
  
  CONCLUSIONS
  In a population of women classified as being eligible for vaginal breech birth, intended vaginal delivery was associated with higher rates of neonatal morbidity than planned caesarean section.
authors.affiliation: Clinical and Population Perinatal Health Research, Kolling Institute, St Leonards, New South Wales, Australia. yusun.bin@sydney.edu.au.|Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia. yusun.bin@sydney.edu.au.
authors.forename: Yu Sun
authors.identifier: http://orcid.org/0000-0002-4954-2658
authors.initials: YS
authors.lastname: Bin
authors.affiliation: Clinical and Population Perinatal Health Research, Kolling Institute, St Leonards, New South Wales, Australia.|Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Christine L
authors.initials: CL
authors.lastname: Roberts
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Jane B
authors.initials: JB
authors.lastname: Ford
authors.affiliation: Department of Obstetrics and Gynaecology, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Nicholl
mesh_terms: D000328:Adult; D001034:Apgar Score; D001720:Birth Injuries / Q000209:etiology; D001946:Breech Presentation / Q000601:surgery*; D002585:Cesarean Section / Q000706:statistics & numerical data; D036861:Delivery, Obstetric / Q000379:methods / Q000706:statistics & numerical data*; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015931:Intensive Care, Neonatal / Q000706:statistics & numerical data; D009517:New South Wales; D011247:Pregnancy; D047929:Term Birth; D055815:Young Adult
keywords: breech presentation; caesarean section; cohort study; pregnancy outcome; term birth