Here's a flowchart of the comparison groups and their planned vs. actual modes of delivery. Email me if you'd like to read the full text!
Citation
TOIVONEN, E., PALOMÄKI, O., HUHTALA, H. and UOTILA, J. (2012), Selective vaginal breech delivery at term – still an option. Acta Obstetricia et Gynecologica Scandinavica, 91: 1177–1183.Abstract
Objective.
To compare the neonatal outcome between planned vaginal or planned
cesarean section (CS) breech delivery and planned vaginal vertex
delivery at term with singleton fetuses.
Design. A cohort study.
Setting. Delivery Unit, Tampere University Hospital, Finland, with 5200 annual deliveries.
Population. The term breech deliveries over a period of five years (January 2004 to January 2009), a total of 751 breech deliveries, and 257 vertex controls.
Methods. The data were collected from the mother's medical records, including a summary of the newborn. In the case of neonatal health problems, the pediatric records were also examined.
Main outcome measures. Maternal and neonatal mortality and morbidity as defined in the Term Breech Trial. Low Apgar scores or umbilical cord pH as secondary end-points.
Results. There was no neonatal mortality. Severe morbidity was rare in all groups, with no differences between groups. The Apgar scores at one minute were lower in the planned vaginal delivery group compared with the other groups, but there was no difference at the age of five minutes. Significantly more infants in the vaginal delivery group had a cord pH < 7.05. There was one maternal death due to a complicated CS in the planned CS group and none in the other groups. Mothers in the planned CS group suffered significantly more often from massive bleeding and needed transfusions.
Conclusions. Vaginal delivery remains an acceptable option for breech delivery in selected cases.
Design. A cohort study.
Setting. Delivery Unit, Tampere University Hospital, Finland, with 5200 annual deliveries.
Population. The term breech deliveries over a period of five years (January 2004 to January 2009), a total of 751 breech deliveries, and 257 vertex controls.
Methods. The data were collected from the mother's medical records, including a summary of the newborn. In the case of neonatal health problems, the pediatric records were also examined.
Main outcome measures. Maternal and neonatal mortality and morbidity as defined in the Term Breech Trial. Low Apgar scores or umbilical cord pH as secondary end-points.
Results. There was no neonatal mortality. Severe morbidity was rare in all groups, with no differences between groups. The Apgar scores at one minute were lower in the planned vaginal delivery group compared with the other groups, but there was no difference at the age of five minutes. Significantly more infants in the vaginal delivery group had a cord pH < 7.05. There was one maternal death due to a complicated CS in the planned CS group and none in the other groups. Mothers in the planned CS group suffered significantly more often from massive bleeding and needed transfusions.
Conclusions. Vaginal delivery remains an acceptable option for breech delivery in selected cases.
Rixa, I'd like to know more about the authors' definition of "emergency" CS and whether all of the births were hospital births. Since (at least in my area) it is near-impossible to get an OB to attend a vaginal breech delivery, the only option is a skilled homebirth midwife. Would the outcomes be similar for the planned vaginal delivery group if birthing at home vs. hospital? I am not a birth professional, so I guess what I am asking is: if I am attempting vaginal breech at home with a midwife, and fall into the group needing an emergency CS (~25%, grossly assuming similar rates between Finland and my area), a) what are the possible, hypothetical factors causing me to need the CS (educate me, please), and b) would I get the needed CS in time? Thank you in advance for taking the time to answer.
ReplyDeleteKaren,
ReplyDeleteI don't know if I can adequately answer your questions. No one has ever done a study specifically about breech at home so those questions remain unanswered. Let me send you the paper to look over.
I'm guessing emergency CS includes all in-labor unplanned CS as a blanket term...but I'd have to take another look to see how they differentiated it. The decision tree only allows for vaginal births, elective cesareans (so I guess women allotted to the VB group chose cesarean at some later point), and emergency CS, again leading me to suspect the latter term means "unplanned" and can span a range of events.
Could you send me your email address?
kathy _ petersen _ 283 at yahoo dot com -- I'd love to read the full study. Thanks!
ReplyDeleteThe study is definitely only on hospital births. I live in the area, and homebirth here is almost non-existing (Mine was the only one last year). There are no breech at home births during the study.
ReplyDeleteHere most hospital births are attended by a midwife, OB:s only attend when they are needed (for medication or emergencies), but in a vaginal breech birth an OB is always present.