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Vaginal delivery versus caesarean section in preterm breech delivery: a systematic review

Published:October 21, 2013DOI:https://doi.org/10.1016/j.ejogrb.2013.10.017

      Abstract

      There is controversy on the preferred mode of delivery (vaginal delivery (VD) versus caesarean section (CS)) in preterm breech delivery in relation to neonatal outcome. While CS is supposed to be safer for the fetus, arguments against CS can be the increased risk of maternal morbidity, risks for future pregnancies, and costs. Moreover, neonatal respiratory distress syndrome occurs more frequently after CS compared to VD.
      In the past, several RCTs have been started on this subject, but they were all preliminary and stopped due to recruitment difficulties. As the Cochrane review of these RCT's reported on 116 women only, knowledge on the effectiveness of CS and VD can at present only be obtained from non-randomized studies.
      We performed a systematic review and meta-analysis of non-randomized studies that assessed the association between mode of delivery and neonatal mortality in women with preterm breech presentation. We searched Pubmed, Embase and the Cochrane library for articles comparing neonatal mortality after VD versus CS in preterm breech presentation (gestational age 25+0 till 36+6 weeks). Seven studies, involving a total of 3557 women, met the eligibility criteria and were included in this systematic review. The weighted risk of neonatal mortality was 3.8% in the CS group and 11.5% in the VD group (pooled RR 0.63 (95% CI 0.48–0.81)). We conclude that cohort studies indicate that CS reduces neonatal mortality as compared to VD.

      Keywords

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      References

        • Hickok D.E.
        • Gordon D.C.
        • Milberg J.A.
        • Williams M.A.
        • Daling J.R.
        The frequency of breech presentation by gestational age at birth: a large population-based study.
        Am J Obstet Gynecol. 1992; 166: 851-852
        • Mukhopadhyay S.
        • Arulkumaran S.
        Breech delivery.
        Best Pract Res Clin Obstet Gynaecol. 2002; 16: 31-42
        • Hannah M.E.
        • Hannah W.J.
        • Hewson S.A.
        • Hodnett E.D.
        • Saigal S.
        • Willan A.R.
        Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Term Breech Trial Collaborative Group.
        Lancet. 2000; 356: 1375-1383
        • Hofmeyr G.J.
        • Hannah M.E.
        Planned caesarean section for term breech delivery.
        Cochrane Database Syst Rev. 2000; 2: CD000166
      1. LVR data (nationwide perinatal databank in The Netherlands).

        • Su M.
        • McLeod L.
        • Ross S.
        • et al.
        Factors associated with maternal morbidity in the Term Breech Trial.
        J Obstet Gynaecol Can. 2007; 29: 324-330
        • Krantz M.E.
        • Wennergren M.
        • Bengtson L.G.
        • Hjalmarson O.
        • Karlsson K.
        • Sellgren
        Epidemiological analysis of the increased risk of disturbed neonatal respiratory adaptation after caesarean section.
        Acta Paediatr Scand. 1986; 75: 832-839
        • Zlatnik F.J.
        The Iowa premature breech trial.
        Am J Perinatol. 1993; 10: 60-63
        • Penn Z.J.
        • Steer P.J.
        Reasons for declining participation in a prospective randomized trial to determine the optimum mode of delivery of the preterm breech.
        Control Clin Trials. 1990; 11: 226-231
        • Viegas O.A.
        • Ingemarsson I.
        • Sim L.P.
        • et al.
        Collaborative study on preterm breeches: vaginal delivery versus caesarean section.
        Asia Oceania J Obstet Gynaecol. 1985; 11: 349-355
        • Alfirevic Z.
        • Milan S.J.
        • Livio S.
        Ceasarean section versus vaginal delivery for preterm birth in singletons.
        Cochrane Database Syst Rev. 2012; 6: CD000078
        • Karp L.E.
        • Doney J.R.
        • McCarthy T.
        • Meis P.J.
        • Hall M.
        The premature breech: trial of labor or cesarean section.
        Obstet Gynecol. 1979; 53: 88-92
        • Westgren L.M.
        • Songster G.
        • Paul R.H.
        Preterm breech delivery: another retrospective study.
        Obstet Gynecol. 1986; 66: 481-484
        • Emembolu J.
        The preterm breech delivery in Zaria, northern Nigeria.
        Int J Gynaecol Obstet. 1992; 38: 287-291
        • Ingemarsson I.
        • Westgren M.
        • Svenningsen N.W.
        Long-term follow-up of preterm infants in breech presentation delivered by caesarean section. A prospective study.
        Lancet. 1978; 2: 172-175
        • Nisell H.
        • Bistoletti P.
        • Palme C.
        Preterm breech delivery. Early and late complications.
        Acta Obstet Gynecol Scand. 1981; 60: 363-366
        • Gravenhorst J.B.
        • Schreuder A.M.
        • Veen S.
        • et al.
        Breech delivery in very preterm and very low birthweight infants in The Netherlands.
        Br J Obstet Gynaecol. 1993; 100: 411-415
        • Ziadeh S.
        • Abu-Heija A.T.
        • El-Sunna E.
        • El-Jallad M.F.
        • Shatnawi A.
        • Obeidat A.
        Preterm singleton breech in North Jordan: vaginal versus abdominal delivery.
        Gynecol Obstet Invest. 1997; 44: 169-172
        • Wolf H.
        • Schaap A.H.
        • Bruinse H.W.
        • Smolders-de Haas H.
        • van Ertbruggen I.
        • Treffers P.E.
        Vaginal delivery compared with caesarean section in early preterm breech delivery: a comparison of long term outcome.
        Br J Obstet Gynaecol. 1999; 106: 486-491
        • Warke H.S.
        • Saraogi R.M.
        • Sanjanwalla S.M.
        Should a preterm breech go for vaginal delivery or caesarean section.
        J Postgrad Med. 1999; 45: 1-4
        • Herbst A.
        • Kallen K.
        Influence of mode of delivery on neonatal mortality and morbidity in spontaneous preterm breech delivery.
        Eur J Obstet Gynecol Reprod Biol. 2007; 133: 25-29
        • Kayem G.
        • Baumann R.
        • Goffinet F.
        • et al.
        Early preterm breech delivery: is a policy of planned vaginal delivery associated with increased risk of neonatal death?.
        Am J Obstet Gynecol. 2008; 198: e1-e6
        • Malhotra D.
        • Gopalan S.
        • Narang A.
        Preterm breech delivery in a developing country.
        Int J Gynaecol Obstet. 1994; 45: 27-34
        • Van Eyk E.A.
        • Huisjes H.J.
        Neonatal mortality and morbidity associated with preterm breech presentation.
        Eur J Obstet Gynecol Reprod Biol. 1983; 15: 17-23