Term breech deliveries in the Netherlands: Did the increased cesarean rate affect neonatal outcome? A population-based cohort study

Floortje Vlemmix, Lester Bergenhenegouwen, Jelle M. Schaaf, Sabine Ensing, Ageeth N. Rosman, Anita C J Ravelli, Joris A M Van Der Post, Arno Verhoeven, Gerard H. Visser, Ben W J Mol, Marjolein Kok

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

Objective The aim of this study was to evaluate the effect of the increased cesarean rate for term breech presentation on neonatal outcome. We also investigated whether the clinical case selection for vaginal delivery applied by Dutch obstetricians led to an optimization of neonatal outcome, or whether there is still room for improvement in terms of perinatal outcome. Design Retrospective cohort. Setting The Netherlands. Population Singleton term breech deliveries from 37+0 to 41+6 weeks, excluding fetuses with congenital malformations or antenatal death. Method We used data from the Dutch national perinatal registry from 1999 up to 2007. Main outcome measures Perinatal mortality and morbidity. Results We studied 58 320 women with a term breech delivery. There was an increase in the elective cesarean rate (from 24 to 60%). As a consequence, overall perinatal mortality decreased [1.3‰ vs. 0.7‰; odds ratio 0.51 (95% confidence interval 0.28-0.93)], whereas it remained stable in the planned vaginal birth group [1.7‰ vs. 1.6‰; odds ratio 0.96 (95% confidence interval 0.52-1.76)]. The number of cesareans done to prevent one perinatal death was 338. Conclusions Adjustment of the national guidelines after publication of the Term Breech Trial resulted in a shift towards elective cesarean and a decrease of perinatal mortality and morbidity among women delivering a child in breech at term. Still, 40% of these women attempt vaginal birth. The relative safety of an elective cesarean should be weighed against the consequences of a scarred uterus in future pregnancies.

LanguageEnglish
Pages888-896
Number of pages9
JournalActa obstetricia et gynecologica Scandinavica
Volume93
Issue number9
DOIs
Publication statusPublished - 1 Jan 2014

Keywords

  • Breech presentation
  • elective cesarean
  • mode of delivery
  • neonatal morbidity
  • neonatal mortality

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

Cite this

Vlemmix, Floortje ; Bergenhenegouwen, Lester ; Schaaf, Jelle M. ; Ensing, Sabine ; Rosman, Ageeth N. ; Ravelli, Anita C J ; Van Der Post, Joris A M ; Verhoeven, Arno ; Visser, Gerard H. ; Mol, Ben W J ; Kok, Marjolein. / Term breech deliveries in the Netherlands : Did the increased cesarean rate affect neonatal outcome? A population-based cohort study. In: Acta obstetricia et gynecologica Scandinavica. 2014 ; Vol. 93, No. 9. pp. 888-896.
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title = "Term breech deliveries in the Netherlands: Did the increased cesarean rate affect neonatal outcome? A population-based cohort study",
abstract = "Objective The aim of this study was to evaluate the effect of the increased cesarean rate for term breech presentation on neonatal outcome. We also investigated whether the clinical case selection for vaginal delivery applied by Dutch obstetricians led to an optimization of neonatal outcome, or whether there is still room for improvement in terms of perinatal outcome. Design Retrospective cohort. Setting The Netherlands. Population Singleton term breech deliveries from 37+0 to 41+6 weeks, excluding fetuses with congenital malformations or antenatal death. Method We used data from the Dutch national perinatal registry from 1999 up to 2007. Main outcome measures Perinatal mortality and morbidity. Results We studied 58 320 women with a term breech delivery. There was an increase in the elective cesarean rate (from 24 to 60{\%}). As a consequence, overall perinatal mortality decreased [1.3‰ vs. 0.7‰; odds ratio 0.51 (95{\%} confidence interval 0.28-0.93)], whereas it remained stable in the planned vaginal birth group [1.7‰ vs. 1.6‰; odds ratio 0.96 (95{\%} confidence interval 0.52-1.76)]. The number of cesareans done to prevent one perinatal death was 338. Conclusions Adjustment of the national guidelines after publication of the Term Breech Trial resulted in a shift towards elective cesarean and a decrease of perinatal mortality and morbidity among women delivering a child in breech at term. Still, 40{\%} of these women attempt vaginal birth. The relative safety of an elective cesarean should be weighed against the consequences of a scarred uterus in future pregnancies.",
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author = "Floortje Vlemmix and Lester Bergenhenegouwen and Schaaf, {Jelle M.} and Sabine Ensing and Rosman, {Ageeth N.} and Ravelli, {Anita C J} and {Van Der Post}, {Joris A M} and Arno Verhoeven and Visser, {Gerard H.} and Mol, {Ben W J} and Marjolein Kok",
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Vlemmix, F, Bergenhenegouwen, L, Schaaf, JM, Ensing, S, Rosman, AN, Ravelli, ACJ, Van Der Post, JAM, Verhoeven, A, Visser, GH, Mol, BWJ & Kok, M 2014, 'Term breech deliveries in the Netherlands: Did the increased cesarean rate affect neonatal outcome? A population-based cohort study', Acta obstetricia et gynecologica Scandinavica, vol. 93, no. 9, pp. 888-896. https://doi.org/10.1111/aogs.12449

Term breech deliveries in the Netherlands : Did the increased cesarean rate affect neonatal outcome? A population-based cohort study. / Vlemmix, Floortje; Bergenhenegouwen, Lester; Schaaf, Jelle M.; Ensing, Sabine; Rosman, Ageeth N.; Ravelli, Anita C J; Van Der Post, Joris A M; Verhoeven, Arno; Visser, Gerard H.; Mol, Ben W J; Kok, Marjolein.

In: Acta obstetricia et gynecologica Scandinavica, Vol. 93, No. 9, 01.01.2014, p. 888-896.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Term breech deliveries in the Netherlands

T2 - Acta Obstetricia et Gynecologica Scandinavica

AU - Vlemmix, Floortje

AU - Bergenhenegouwen, Lester

AU - Schaaf, Jelle M.

AU - Ensing, Sabine

AU - Rosman, Ageeth N.

AU - Ravelli, Anita C J

AU - Van Der Post, Joris A M

AU - Verhoeven, Arno

AU - Visser, Gerard H.

AU - Mol, Ben W J

AU - Kok, Marjolein

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Objective The aim of this study was to evaluate the effect of the increased cesarean rate for term breech presentation on neonatal outcome. We also investigated whether the clinical case selection for vaginal delivery applied by Dutch obstetricians led to an optimization of neonatal outcome, or whether there is still room for improvement in terms of perinatal outcome. Design Retrospective cohort. Setting The Netherlands. Population Singleton term breech deliveries from 37+0 to 41+6 weeks, excluding fetuses with congenital malformations or antenatal death. Method We used data from the Dutch national perinatal registry from 1999 up to 2007. Main outcome measures Perinatal mortality and morbidity. Results We studied 58 320 women with a term breech delivery. There was an increase in the elective cesarean rate (from 24 to 60%). As a consequence, overall perinatal mortality decreased [1.3‰ vs. 0.7‰; odds ratio 0.51 (95% confidence interval 0.28-0.93)], whereas it remained stable in the planned vaginal birth group [1.7‰ vs. 1.6‰; odds ratio 0.96 (95% confidence interval 0.52-1.76)]. The number of cesareans done to prevent one perinatal death was 338. Conclusions Adjustment of the national guidelines after publication of the Term Breech Trial resulted in a shift towards elective cesarean and a decrease of perinatal mortality and morbidity among women delivering a child in breech at term. Still, 40% of these women attempt vaginal birth. The relative safety of an elective cesarean should be weighed against the consequences of a scarred uterus in future pregnancies.

AB - Objective The aim of this study was to evaluate the effect of the increased cesarean rate for term breech presentation on neonatal outcome. We also investigated whether the clinical case selection for vaginal delivery applied by Dutch obstetricians led to an optimization of neonatal outcome, or whether there is still room for improvement in terms of perinatal outcome. Design Retrospective cohort. Setting The Netherlands. Population Singleton term breech deliveries from 37+0 to 41+6 weeks, excluding fetuses with congenital malformations or antenatal death. Method We used data from the Dutch national perinatal registry from 1999 up to 2007. Main outcome measures Perinatal mortality and morbidity. Results We studied 58 320 women with a term breech delivery. There was an increase in the elective cesarean rate (from 24 to 60%). As a consequence, overall perinatal mortality decreased [1.3‰ vs. 0.7‰; odds ratio 0.51 (95% confidence interval 0.28-0.93)], whereas it remained stable in the planned vaginal birth group [1.7‰ vs. 1.6‰; odds ratio 0.96 (95% confidence interval 0.52-1.76)]. The number of cesareans done to prevent one perinatal death was 338. Conclusions Adjustment of the national guidelines after publication of the Term Breech Trial resulted in a shift towards elective cesarean and a decrease of perinatal mortality and morbidity among women delivering a child in breech at term. Still, 40% of these women attempt vaginal birth. The relative safety of an elective cesarean should be weighed against the consequences of a scarred uterus in future pregnancies.

KW - Breech presentation

KW - elective cesarean

KW - mode of delivery

KW - neonatal morbidity

KW - neonatal mortality

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