E Lorthe1,2, L Sentilhes3, M Quere1, C Lebeaux4, N Winer5,6, H Torchin1,7, F Goffinet1,8, P Delorme1,8, G Kayem1,9. 1. Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France. 2. EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal. 3. Department of Obstetrics and Gynaecology, Bordeaux University Hospital, Bordeaux, France. 4. Reference Centre on Teratogenic Agents, Trousseau University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France. 5. Department of Obstetrics and Gynecology, CIC Mère Enfant, University Hospital, Nantes, France. 6. INRA, UMR 1280, Physiologie des adaptations nutritionnelles, Nantes, France. 7. Neonatal Medicine and Resuscitation Service, Port-Royal, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris, Paris, France. 8. Department of Obstetrics and Gynaecology, Cochin, Broca, Hôtel-Dieu, Assistance Publique - Hôpitaux de Paris, Paris, France. 9. Department of Obstetrics and Gynaecology, Trousseau University Hospital, Assistance Publique - Hôpitaux de Paris, Sorbonne Universités, Université Pierre and Marie Curie Paris 06, Paris, France.
Abstract
OBJECTIVE: To assess whether planned route of delivery is associated with perinatal and 2-year outcomes for preterm breech singletons. DESIGN: Prospective nationwide population-based EPIPAGE-2 cohort study. SETTING: France, 2011. SAMPLE: Three hundred and ninety women with breech singletons born at 26-34 weeks of gestation after preterm labour or preterm prelabour rupture of membranes. METHODS: Propensity-score analysis. MAIN OUTCOME MEASURES: Survival at discharge, survival at discharge without severe morbidity, and survival at 2 years of corrected age without neurosensory impairment. RESULTS: Vaginal and caesarean deliveries were planned in 143 and 247 women, respectively. Neonates with planned vaginal delivery and planned caesarean delivery did not differ in survival (93.0 versus 95.7%, P = 0.14), survival at discharge without severe morbidity (90.4 versus 89.9%, P = 0.85), or survival at 2 years without neurosensory impairment (86.6 versus 91.6%, P = 0.11). After applying propensity scores and assigning inverse probability of treatment weighting, as compared with planned vaginal delivery, planned caesarean delivery was not associated with improved survival (odds ratio, OR 1.31; 95% confidence interval, 95% CI 0.67-2.59), survival without severe morbidity (OR 0.75, 95% CI 0.45-1.27), or survival at 2 years without neurosensory impairment (OR 1.04, 95% CI 0.60-1.80). Results were similar after matching on propensity score. CONCLUSIONS: No association between planned caesarean delivery and improved outcomes for preterm breech singletons born at 26-34 weeks of gestation after preterm labour or preterm prelabour rupture of membranes was found. The route of delivery should be discussed with women, balancing neonatal outcomes with the higher risks of maternal morbidity associated with caesarean section performed at low gestational age.
OBJECTIVE: To assess whether planned route of delivery is associated with perinatal and 2-year outcomes for preterm breech singletons. DESIGN: Prospective nationwide population-based EPIPAGE-2 cohort study. SETTING: France, 2011. SAMPLE: Three hundred and ninety women with breech singletons born at 26-34 weeks of gestation after preterm labour or preterm prelabour rupture of membranes. METHODS: Propensity-score analysis. MAIN OUTCOME MEASURES: Survival at discharge, survival at discharge without severe morbidity, and survival at 2 years of corrected age without neurosensory impairment. RESULTS: Vaginal and caesarean deliveries were planned in 143 and 247 women, respectively. Neonates with planned vaginal delivery and planned caesarean delivery did not differ in survival (93.0 versus 95.7%, P = 0.14), survival at discharge without severe morbidity (90.4 versus 89.9%, P = 0.85), or survival at 2 years without neurosensory impairment (86.6 versus 91.6%, P = 0.11). After applying propensity scores and assigning inverse probability of treatment weighting, as compared with planned vaginal delivery, planned caesarean delivery was not associated with improved survival (odds ratio, OR 1.31; 95% confidence interval, 95% CI 0.67-2.59), survival without severe morbidity (OR 0.75, 95% CI 0.45-1.27), or survival at 2 years without neurosensory impairment (OR 1.04, 95% CI 0.60-1.80). Results were similar after matching on propensity score. CONCLUSIONS: No association between planned caesarean delivery and improved outcomes for preterm breech singletons born at 26-34 weeks of gestation after preterm labour or preterm prelabour rupture of membranes was found. The route of delivery should be discussed with women, balancing neonatal outcomes with the higher risks of maternal morbidity associated with caesarean section performed at low gestational age.
Authors: Maiju Kekki; Topias Koukkula; Anne Salonen; Mika Gissler; Hannele Laivuori; Tuomas T Huttunen; Kati Tihtonen Journal: Arch Gynecol Obstet Date: 2022-09-08 Impact factor: 2.493
Authors: Maria Lindblad; Ann Josefsson; Marie Bladh; Gunilla Sydsjö; Torsten Johansson Journal: BMC Pregnancy Childbirth Date: 2020-03-30 Impact factor: 3.007