BACKGROUND: To determine the factors associated with the risk of delivery-related perinatal and neonatal death among term infants presenting by the breech and the effect of changes in the mode of delivery on the overall rates of perinatal and neonatal mortality associated with breech presentation. METHODS: We studied 32,776 singleton term infants presenting breech excluding anomalous and antepartum losses in Scotland between 1985 and 2004, using linked Scottish national registries of pregnancy outcome data and perinatal death data. The event was delivery-related perinatal and neonatal death (i.e. intrauterine fetal death during labour or death of infant in the first 4 weeks of life), subdivided according to intrapartum anoxia or mechanical cause of death. Analysis was by multivariate logistic regression. RESULTS: During the study period, the risk of delivery-related perinatal and neonatal death decreased by 72% (95% CI -1% to 93%), due to a 90% (95% CI 33-99%) reduction in anoxic or mechanical deaths. Both intrapartum (OR 0.16, 95% CI 0.02-0.75) and planned (OR 0.01, 95% CI 0.00-0.09) caesarean delivery were protective against anoxic or mechanical deaths and increased use of planned caesarean delivery accounted for 16% of the decline in anoxic and mechanical deaths over the study period. CONCLUSION: Increased use of planned caesarean delivery only partly explains the decline in delivery-related perinatal and neonatal death between 1985 and 2004 in Scotland.
BACKGROUND: To determine the factors associated with the risk of delivery-related perinatal and neonatal death among term infants presenting by the breech and the effect of changes in the mode of delivery on the overall rates of perinatal and neonatal mortality associated with breech presentation. METHODS: We studied 32,776 singleton term infants presenting breech excluding anomalous and antepartum losses in Scotland between 1985 and 2004, using linked Scottish national registries of pregnancy outcome data and perinatal death data. The event was delivery-related perinatal and neonatal death (i.e. intrauterine fetal death during labour or death of infant in the first 4 weeks of life), subdivided according to intrapartum anoxia or mechanical cause of death. Analysis was by multivariate logistic regression. RESULTS: During the study period, the risk of delivery-related perinatal and neonatal death decreased by 72% (95% CI -1% to 93%), due to a 90% (95% CI 33-99%) reduction in anoxic or mechanical deaths. Both intrapartum (OR 0.16, 95% CI 0.02-0.75) and planned (OR 0.01, 95% CI 0.00-0.09) caesarean delivery were protective against anoxic or mechanical deaths and increased use of planned caesarean delivery accounted for 16% of the decline in anoxic and mechanical deaths over the study period. CONCLUSION: Increased use of planned caesarean delivery only partly explains the decline in delivery-related perinatal and neonatal death between 1985 and 2004 in Scotland.
Authors: Gordon Cs Smith; Alexandros A Moraitis; David Wastlund; Jim G Thornton; Aris Papageorghiou; Julia Sanders; Alexander Ep Heazell; Stephen C Robson; Ulla Sovio; Peter Brocklehurst; Edward Cf Wilson Journal: Health Technol Assess Date: 2021-02 Impact factor: 4.014
Authors: Daniel F Mackay; Rachael Wood; Albert King; David N Clark; Sally-Ann Cooper; Gordon C S Smith; Jill P Pell Journal: Int J Epidemiol Date: 2015-01-21 Impact factor: 7.196
Authors: David Wastlund; Alexandros A Moraitis; Alison Dacey; Ulla Sovio; Edward C F Wilson; Gordon C S Smith Journal: PLoS Med Date: 2019-04-16 Impact factor: 11.069