Changes in vaginal breech delivery rates in a single large metropolitan area.

Abstract:

OBJECTIVE:Vaginal breech delivery rates have been accepted widely to be in decline and the Term Breech Trial (TBT) has recommended delivery of a breech-presenting infant by elective cesarean section delivery. Our aim was to examine the rate of vaginal delivery of term breech pregnancies in the 8 years before and after the publication of the TBT. STUDY DESIGN:We retrospectively examined vaginal delivery rates of breech presentations over a 16-year period in 3 large tertiary maternity hospitals that serve a single large metropolitan population. All 3 hospitals are of similar size and serve a population with similar risk profile. We also examined rates of perinatal mortality in the 3 hospitals over the study period. RESULTS:During the 16-year study period, there were 344,259 deliveries among the 3 hospitals; 11,913 of which were breech deliveries. There were 5655 breech deliveries in the 8 years before the publication of the TBT, with a cesarean delivery rate of 76.9%. There were 6258 breech deliveries in the 8 years since publication of the TBT, and the cesarean delivery rate increased to 89.7% (P < .0001). During the 8 years since publication, the rate of vaginal delivery in nulliparous women decreased from 15.3-7.2% (P < .0001). The vaginal breech delivery rate in multiparous women decreased from 32.6-14.8% (P < .0001). The rates of corrected perinatal mortality showed a significant decrease in the last 4 years of the study. CONCLUSION:Our study demonstrates that the results and recommendations of the TBT have contributed to decreasing vaginal breech delivery rates, which were already in decline before its publication.

journal_name

Am J Obstet Gynecol

authors

Hehir MP,O'Connor HD,Kent EM,Fitzpatrick C,Boylan PC,Coulter-Smith S,Geary MP,Malone FD

doi

10.1016/j.ajog.2012.03.029

subject

Has Abstract

pub_date

2012-06-01 00:00:00

pages

498.e1-4

issue

6

eissn

0002-9378

issn

1097-6868

pii

S0002-9378(12)00329-8

journal_volume

206

pub_type

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