Factors associated with adverse perinatal outcome in the Term Breech Trial

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Abstract

Background

In the Term Breech Trial, the risk of adverse perinatal outcome was lower with planned cesarean section versus planned vaginal birth. We undertook secondary analyses to determine factors associated with adverse perinatal outcome.

Study design

By using multiple logistic regression analyses, we determined the effect of prelabor cesarean section, cesarean section during early labor, cesarean section during active labor versus vaginal birth, and other factors, on adverse perinatal outcome. For 1384 fetuses delivered after labor, we determined the effect of variables associated with labor on adverse perinatal outcome.

Results

The risk of adverse perinatal outcome was lowest with prelabor cesarean section (odds ratio [OR] = 0.13) and highest with vaginal birth. For those delivered after labor, labor augmentation (P = .007), birth weight less than 2.8 kg (P = .003), and longer time between pushing and delivery (P<.001) increased the risk, whereas the presence of an experienced clinician at delivery (P = .004) reduced the risk of adverse perinatal outcome.

Conclusion

Breech infants at term are best delivered by prelabor cesarean section.

Section snippets

Methods

We studied the effect of mode of delivery and the effect of variables associated with labor, on adverse perinatal outcome, in two steps, that is, using two separate regression analyses because these variables are very highly correlated with each other. In the first step we included mode of delivery but not factors associated with labor; in the second step, we included factors associated with labor but not mode of delivery. Active labor was defined as contractions 5 minutes or less apart and the

Effect of mode of delivery on adverse perinatal outcome

Single-factor analyses found no significant associations between baseline characteristics and adverse perinatal outcome (Table I). Mode of delivery (P<.001) and birth weight (P = .007) were both associated with adverse perinatal outcome on single-factor analyses (Table II).

Multiple logistic regression analyses found mode of delivery (P<.001) and birth weight (P = .03) to be both significantly associated with adverse perinatal outcome (Table III). There was no significant interaction between mode of

Comment

This secondary analysis of data from the Term Breech Trial found a prelabor cesarean section to be associated with the lowest risk of adverse perinatal outcome for the singleton fetus in breech presentation at term. The risk was higher if a cesarean section was undertaken during early labor, higher still if a cesarean section was undertaken during active labor, and highest if a vaginal birth occurred. There was thus a dose-response relationship between the progression of labor and the risk of

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    Supported by the Canadian Institutes of Health Research (CIHR, previously the Medical Research Council of Canada), grant No. MT 13884. M. E.H. holds a CIHR Senior Scientist Award. The Data Coordinating Centre was supported by grants from the Centre for Research in Women's Health, Sunnybrook and Women's College Health Sciences Centre, and the Department of Obstetrics and Gynecology at the University of Toronto.

    Presented at the Twenty-Third Annual Meeting of the Society for Maternal-Fetal Medicine, San Francisco, Calif, February 3-8, 2003.

    The members of the Term Breech Trial Collaborative Group are listed in Hannah ME, Hannah WJ, Hewson SA, Hodnett ED, Saigal S, Willan AR, for the Term Breech Trial Collaborative Group. Planned cesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Lancet 2000;356:1375-83.

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