J L Kiely1. 1. Gertrude H. Sergievsky Center, Faculty of Medicine, Columbia University, New York 10032.
Abstract
OBJECTIVE: To study the effects of caesarean section on neonatal mortality in infants presenting by the breech. DESIGN: Population-based non-experimental comparison of infants presenting by the breech born vaginally with those born by caesarean section. Neonatal mortality rates were calculated for 250 g birthweight intervals. Weight-specific relative risks (RRs) were further adjusted for birthweight in 50 g categories. SETTING: New York City, 1978-1983. Data came from the Department of Health's computerized vital records on livebirths and infant deaths. SUBJECTS: 17,587 singleton breech livebirths greater than or equal to 500 g birthweight, with congenital anomaly deaths excluded. 6178 were born vaginally and 11409 were born by caesarean section. MAIN OUTCOME MEASURES: Birthweight-specific and birthweight-adjusted neonatal mortality. RESULTS: At birthweights of 501 to 1750 g, the risk of neonatal death for breech infants born vaginally was significantly higher than the risk for those born by caesarean section (weight-adjusted RR = 1.7). For breech infants with birthweights over 3000 g, the weight-adjusted risk was 5.6 times greater for a vaginal birth compared with caesarean section. The addition of 16 additional control variables in multiple logistic regression analyses did not change these RRs. CONCLUSION: Population-based studies indicate that an increase in the caesarean section rate among breech singletons may be associated with increased neonatal survival, but a large multicentre randomized trial of management of breech presentation would answer the question much more definitively.
OBJECTIVE: To study the effects of caesarean section on neonatal mortality in infants presenting by the breech. DESIGN: Population-based non-experimental comparison of infants presenting by the breech born vaginally with those born by caesarean section. Neonatal mortality rates were calculated for 250 g birthweight intervals. Weight-specific relative risks (RRs) were further adjusted for birthweight in 50 g categories. SETTING: New York City, 1978-1983. Data came from the Department of Health's computerized vital records on livebirths and infant deaths. SUBJECTS: 17,587 singleton breech livebirths greater than or equal to 500 g birthweight, with congenital anomaly deaths excluded. 6178 were born vaginally and 11409 were born by caesarean section. MAIN OUTCOME MEASURES: Birthweight-specific and birthweight-adjusted neonatal mortality. RESULTS: At birthweights of 501 to 1750 g, the risk of neonatal death for breech infants born vaginally was significantly higher than the risk for those born by caesarean section (weight-adjusted RR = 1.7). For breech infants with birthweights over 3000 g, the weight-adjusted risk was 5.6 times greater for a vaginal birth compared with caesarean section. The addition of 16 additional control variables in multiple logistic regression analyses did not change these RRs. CONCLUSION: Population-based studies indicate that an increase in the caesarean section rate among breech singletons may be associated with increased neonatal survival, but a large multicentre randomized trial of management of breech presentation would answer the question much more definitively.
Authors: Uma M Reddy; Jun Zhang; Liping Sun; Zhen Chen; Tonse N K Raju; S Katherine Laughon Journal: Am J Obstet Gynecol Date: 2012-06-19 Impact factor: 8.661