Fetal outcome of vaginally delivered breech presentation infants born preterm as good as breech presentation infants born by Caesarean section?

Ziel: To compare vaginally delivered preterm singleton and twin infants in breech presentation in fetal outcome to Caesarean section delivered ones with a special medical indication such as "breech presentation" or "twins" or "Caesarean section on demand" or a combination of these three indications.

Methodik: Out of the 346 live-born singleton and twin breech infants, born from 24+0 to 37+0 gestational weeks, at the University Hospital Salzburg over a 10-year study period, 4 preterm singletons and 17 preterm twins with a special medical indication were Caesarean section, 17 preterm singletons and 19 preterm twins vaginally delivered. The 36 vaginally and Caesarean section delivered breech twins are used for statistical analysis, performed with SPSS 19. The criteria for comparison in fetal outcome are birth weight, head circumference, transfer rate to Neonatal Intensive Care Unit, the arterial and venous umbilical cord blood pH and base excess.

Ergebnis: In singleton preterm breech presentation infants with a special medical indication a statistical analysis was not possible due to the small sample size. Vaginally delivered preterm breech presentation twins with a special medical indication show lower values in birth weight, head circumference, arterial umbilical cord blood pH and base excess, but no significant difference was observed in the venous umbilical cord blood pH and base excess and the transfer rate to NICU.

Schlussfolgerung: The comparison of the fetal outcome of Caesarean section delivered breech infants with a special medical indication to the vaginal delivery group did not allow a reliable statistical analysis due to the too small samples size and the difference in the maturity of the infants did not make a valid comparison. In sum, a general recommendation on the obstetrical management of preterm breech infants cannot be given, but with the data available – and it will be difficult to generate more data–a policy of routine Caesarean section is not necessarily justified, either.

Caesarean section - breech presentation - fetal outcome - mode of delivery - preterm - vaginal delivery