title: Long-term childhood outcomes of breech presentation by intended mode of delivery: a population record linkage study.
abstract: BACKGROUND
  There is a lack of information on long-term outcomes by mode of delivery for term breech presentation. We aimed to compare childhood mortality, cerebral palsy, hospitalizations, developmental, and educational outcomes associated with intended vaginal breech birth (VBB) with planned cesarean section.
  
  
  METHODS
  Population birth and hospital records from New South Wales, Australia, were used to identify women with non-anomalous pregnancies eligible for VBB during 2001-2012. Intended mode of delivery was inferred from labor onset and management. Death, hospital, and education records were used for follow up until 2014. Cox proportional hazards regression and modified Poisson regression were used for analysis.
  
  
  RESULTS
  Of 15 281 women considered eligible for VBB, 7.7% intended VBB, 74.2% planned cesarean section, and intention was uncertain for 18.1%. Intended VBB did not differ from planned cesarean section on infant mortality (Fisher's exact p = 0.55), childhood mortality (Fisher's exact p = 0.50), cerebral palsy (Fisher's exact p = 1.00), hospitalization in the first year of life [adjusted hazard ratio (HR) 1.04; 95% CI 0.90-1.20], hospitalization between the first and sixth birthdays (HR 0.92; 95% CI 0.82-1.04), being developmentally vulnerable [adjusted relative risk (RR) 1.22; 95% CI 0.48-1.69] or having special needs status (RR 0.95; 95% CI 0.48-1.88) when aged 4-6, or scoring more than 1 standard deviation below the mean on tests of reading (RR 1.10; 95% CI 0.87-1.40) and numeracy (RR 1.04; 95% CI 0.81-1.34) when aged 7-9.
  
  
  CONCLUSIONS
  Planned VBB confers no additional risks for child health, development or educational achievement compared with planned cesarean section.
authors.affiliation: Clinical and Population Perinatal Health Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia.|Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.
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, Northern Sydney Local Health District, St Leonards, NSW, Australia.|Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.
authors.forename: Jane B
authors.identifier: http://orcid.org/0000-0001-7272-7733
authors.initials: JB
authors.lastname: Ford
authors.affiliation: Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.|Department of Obstetrics and Gynecology, Royal North Shore Hospital, St Leonards, NSW, Australia.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Nicholl
authors.affiliation: Clinical and Population Perinatal Health Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia.|Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.
authors.forename: Christine L
authors.identifier: http://orcid.org/0000-0002-9808-7647
authors.initials: CL
authors.lastname: Roberts
mesh_terms: D000328:Adult; D001946:Breech Presentation; D002547:Cerebral Palsy / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D036861:Delivery, Obstetric / Q000379:methods; D005260:Female; D006801:Humans; D008498:Medical Record Linkage; D009517:New South Wales / Q000453:epidemiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D012042:Registries; D017741:Survivors / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Breech presentation; cerebral palsy; cesarean section; cohort study; developmental disabilities; educational achievement; hospitalization; infant mortality