Risk factors for adverse outcomes in vaginal preterm breech labor

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Toijonen , A , Heinonen , S , Gissler , M & Macharey , G 2021 , ' Risk factors for adverse outcomes in vaginal preterm breech labor ' , Archives of Gynecology and Obstetrics , vol. 303 , no. 1 , pp. 93–101 . https://doi.org/10.1007/s00404-020-05731-y

Title: Risk factors for adverse outcomes in vaginal preterm breech labor
Author: Toijonen, Anna; Heinonen, Seppo; Gissler, Mika; Macharey, Georg
Contributor organization: Department of Obstetrics and Gynecology
HUS Gynecology and Obstetrics
Helsinki University Hospital Area
University of Helsinki
HUS Psychiatry
Department of Psychiatry
Doctoral Programme in Clinical Research
Date: 2021-01
Language: eng
Number of pages: 9
Belongs to series: Archives of Gynecology and Obstetrics
ISSN: 0932-0067
DOI: https://doi.org/10.1007/s00404-020-05731-y
URI: http://hdl.handle.net/10138/325909
Abstract: Purpose To assess the risk factors for adverse outcomes in attempted vaginal preterm breech deliveries. Methods A retrospective case-control study, including 2312 preterm breech deliveries (24 + 0 to 36 + 6 gestational weeks) from 2004 to 2018 in Finland. The preterm breech fetuses with adverse outcomes born vaginally or by emergency cesarean section were compared with the fetuses without adverse outcomes with the same gestational age. A multivariable logistic regression analysis was used to calculate the risk factors for adverse outcomes (umbilical arterial pH below 7, 5-min Apgar score below 4, intrapartum stillbirth and neonatal death <28 days of age). Results Adverse outcome in vaginal preterm breech delivery was associated with maternal obesity (aOR 32.19, CI 2.97-348.65), smoking (aOR 2.29, CI 1.12-4.72), congenital anomalies (aOR 4.50, 1.56-12.96), preterm premature rupture of membranes (aOR 1.87, CI 1.00-3.49), oligohydramnios (28-32 weeks of gestation: aOR 6.50, CI 2.00-21.11, 33-36 weeks of gestation: aOR 19.06, CI 7.15-50.85), epidural anesthesia in vaginal birth (aOR 2.44, CI 1.19-5.01), and fetal growth below the second standard deviation (28-32 weeks of gestation: aOR 5.89, CI 1.00-34.74, 33-36 weeks of gestation: aOR 12.27, CI 2.81-53.66). Conclusion The study shows that for each subcategory of preterm birth, there are different risk factors for adverse neonatal outcomes in planned vaginal breech delivery. Due to the extraordinary increased risk of adverse outcomes, we would recommend a planned cesarean section in very preterm breech presentation (28 + 0 to 32 + 6 weeks) with severe maternal obesity, oligohydramnios, or fetal growth restriction and in moderate to late preterm breech presentation (33 + 0 to 36 + 6 weeks) with oligohydramnios or fetal growth restriction.
Description: cited By 0
Subject: Adverse outcome
Breech presentation
Preterm delivery
Preterm labor
Risk factor
Vaginal labor
3123 Gynaecology and paediatrics
Peer reviewed: Yes
Rights: cc_by
Usage restriction: openAccess
Self-archived version: publishedVersion

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