Risk factors associated with adverse perinatal outcome in planned vaginal breech labors at term: a retrospective population-based case-control study.
Vaginal breech delivery is associated with adverse perinatal outcome. The aim of this study was to identify factors associated with adverse perinatal outcome in term breech pregnancies, and to provide clinicians an aid in selecting women for a trial of vaginal labor with the fetus in breech position.



We conducted a retrospective, nationwide, Finnish population-based case-control study. All planned singleton vaginal deliveries at term with the fetus in breech position between the years 2005 and 2014 were analyzed. The study's end point was a composite set of adverse perinatal outcomes. All infants with an adverse outcome were compared to the infants with normal outcomes. A multivariate logistic regression model was used to analyze the data.



An adverse perinatal outcome was recorded for 73 (1.5%) infants. According to the study results fetal growth restriction (adjusted odds ratio, 2.94; 95% CI, 1.30-6.67), oligohydramnios (adjusted odds ratio, 2.94; 95% CI, 1.15-7.18), a history of cesarean section (adjusted odds ratio, 2.94; 95% CI, 1.28-6.77, gestational diabetes (adjusted odds ratio, 2.89; 95% CI, 1.54-5.40), epidural anesthesia (adjusted odds ratio, 2.20; 95% CI, 1.29-3.75) and nulliparity (adjusted odds ratio, 1.84; 95% CI, 1.10-3.08) were associated with adverse perinatal outcome.



Adverse perinatal outcome in planned vaginal breech labor at term is associated with fetal growth restriction, oligohydramnios, previous cesarean delivery, gestational diabetes, nulliparity and epidural anesthesia.
Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. georg.Macharey@hus.fi.
Georg
0000-0002-3337-3896
G
Macharey
THL National Institute for Health and Welfare, Helsinki, Finland.
Mika
M
Gissler
Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Veli-Matti
VM
Ulander
Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Leena
L
Rahkonen
Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Mervi
M
Väisänen-Tommiska
Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Mika
M
Nuutila
Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Seppo
S
Heinonen
D000328:Adult; D000767:Anesthesia, Epidural / Q000706:statistics & numerical data; D001946:Breech Presentation; D016022:Case-Control Studies; D002585:Cesarean Section / Q000706:statistics & numerical data; D036861:Delivery, Obstetric / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005387:Finland; D005865:Gestational Age; D006801:Humans; D016015:Logistic Models; D016017:Odds Ratio; D010298:Parity; D018743:Perinatal Care / Q000379:methods*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012307:Risk Factors; D047929:Term Birth
Breech presentation; Cesarean section; Fetal growth restriction; Gestational diabetes; Macrosomia; Oligohydramnios; Perinatal morbidity; Perinatal mortality; Risk factors