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Is vaginal breech delivery associated with higher risk for perinatal death and cerebral palsy compared with vaginal cephalic birth? Registry-based cohort study in Norway
  1. Solveig Bjellmo1,2,
  2. Guro L Andersen2,3,
  3. Marit Petra Martinussen2,4,5,
  4. Pål Richard Romundstad2,6,
  5. Sissel Hjelle1,
  6. Dag Moster7,8,
  7. Torstein Vik2,4
  1. 1 Department of Obstetrics and Gynecology, Helse More og Romsdal HF, Alesund, Norway
  2. 2 The Norwegian University of Science and Technology, NTNU, Trondheim, Norway
  3. 3 The Cerebral Palsy Registry of Norway, Habilitation Center, Vestfold Hospital, Tønsberg, Norway
  4. 4 Department of Laboratory Medicine, Children’s and Women’s Health, LBK, Trondheim, Norway
  5. 5 Department of Obstetrics and Gynecology, St Olav`s Hospital, Trondheim, Norway
  6. 6 Department of Public Health, Norwegian University of Science and Technology, Trondheim, Norway
  7. 7 Institute of Global Public Health and Primary Care, UiB, Bergen, Norway
  8. 8 Department of Paediatrics, Hauekland University Hospital, Bergen, Norway
  1. Correspondence to Dr Solveig Bjellmo; sbjellmo{at}hotmail.com

Abstract

Objective This paper aims to study if vaginal breech delivery is associated with increased risk for neonatal mortality (NNM) or cerebral palsy (CP) in Norway where vaginal delivery accounts for 1/3 of all breech deliveries.

Design Cohort study using information from the national Medical BirthRegister and Cerebral Palsy Register.

Setting Births in Norway 1999–2009.

Participants 520 047 term-born singletons without congenital malformations.

Main outcome measures NNM, CP and a composite outcome of these and death during birth.

Results Compared with cephalic births, breech births had substantially increased risk for NNM but not for CP. Vaginal delivery was planned for 7917 of 16 700 fetuses in breech, while 5561 actually delivered vaginally. Among these, NNM was 0.9 per 1000 compared with 0.3 per 1000 in vaginal cephalic delivery, and 0.8 per 1000 in those actually born by caesarean delivery (CD) in breech. Compared with planned cephalic delivery, planned vaginal delivery was associated with excess risk for NNM (OR 2.4; 95% CI 1.2 to 4.9), while the OR associated with planned breech CD was 1.6 (95% CI 0.7 to 3.7). These risks were attenuated when NNM was substituted by the composite outcome. Vaginal breech delivery was not associated with excess risk for CP compared with vaginal cephalic delivery.

Conclusion Vaginal breech delivery, regardless of whether planned or actual, and actual breech CD were associated with excess risk for NNM compared with vaginal cephalic delivery, but not with CP. The risk for NNM and CP in planned breech CD did not differ significantly from planned vaginal cephalic delivery. However, the absolute risk for these outcomes was low, and taking into consideration potential long-term adverse consequences of CD for the child and later deliveries, we therefore conclude that vaginal breech delivery may be recommended, provided competent obstetric care and strict criteria for selection to vaginal delivery.

  • breech delivery
  • epidemiology
  • cerebral palsy
  • perinatal mortality

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Footnotes

  • Contributors SB analysed the data, contributed to study design and data interpretation and wrote the first draft of the manuscript. GA was principally responsible for the data from the CPRN and revised the manuscript. MM contributed to the data interpretation and revised the manuscript. PR contributed to the research hypotheses, study design and revised the manuscript. SH contributed to the data interpretation and revised the manuscript. DM contributed to study design, the data analyses, data interpretation and revised the manuscript. TV proposed the research questions and contributed in the interpretation of the data and the revision of the manuscript. He is the guarantor of the study and accepts full responsibility for the work and the conduct of the study. All authors approved the final version of the submitted manuscript.

  • Funding Supported by a grant from The Liaison Committee between the Central Norway Regional Health Authority (RHA) and the Norwegian University of Science and Technology (NTNU).

  • Competing interests All authors have completed the ICMJE uniform disclosure form at www.icmj.org/cio_disclosure.pdf (available on request from the corresponding author) and declare: no financial support from any organisation for the submitted work; no financial relationship with any companies that might have an interest in the submitted work in the previous 3 years and have no non-financial interests or relationships that may be relevant to the submitted work.

  • Ethics approval The study was approved by the Regional Ethical Committee for Medical Research in Mid-Norway (ref. 2011/754).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The protocol is available on request from the corresponding author at: sbjellmo@hotmail.com.

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