Preterm Breech Presentation: A Comparison of Intended Vaginal and Intended Cesarean Delivery

OBJECTIVE:To study the association of the intended mode of delivery and perinatal morbidity and mortality among breech fetuses who are delivered preterm. METHODS:We conducted a nationwide cohort study of women with a singleton pregnancy in breech presentation who delivered preterm (26 0/7–36 6/7 weeks of gestation) in the years 2000–2011. We compared perinatal outcomes according to the intended and actual mode of delivery using multivariate logistic regression analysis. We performed subgroup analyses of gestational age and parity. RESULTS:We studied 8,356 women with a preterm singleton breech delivery. Intended cesarean delivery (n=1,935) was not associated with a significant reduction in perinatal mortality compared with intended vaginal delivery (n=6,421) (1.3% compared with 1.5%; adjusted odds ratio [OR] 0.97, 95% confidence interval [CI] 0.60–1.57). However, the composite of perinatal mortality and morbidity was significantly reduced in the intended cesarean delivery group (8.7% compared with 10.4%; adjusted OR 0.77, 95% CI 0.63–0.93). In the subgroup of women delivering at 28–32 weeks of gestation, intended cesarean delivery was associated with a 1.7% risk of perinatal mortality compared with 4.1% with intended vaginal delivery (adjusted OR 0.27, 95% CI 0.10–0.77) and significantly reduced composite mortality and severe morbidity, 5.9% compared with 10.1% (adjusted OR 0.37, 95% CI 0.20–0.68). CONCLUSION:In women delivering a preterm breech fetus, cesarean delivery is associated with reduced perinatal mortality and morbidity. LEVEL OF EVIDENCE:II