Undiagnosed term breech: Impact on mode of delivery and neonatal outcome

Abstract

Background. The purpose of this study was to compare delivery mode and neonatal outcome in breech pregnancies diagnosed antepartum (Dx group) with those diagnosed on admission for delivery or intrapartum (No-Dx group). Methods. During an 11-year period, breech pregnancies ≥34 weeks' gestation with a live nonanomalous fetus were reviewed. The Dx group was matched for gestational age, parity, and maternal age to the No-Dx group (n = 256) and compared using the χ2-test, the Mc-Nemar test, and the Wilcoxon rank test. A p-value of <0.05 was considered significant. Results. Breech type and birthweights were similar in the two groups. In the No-Dx group, 19.5% did not receive prenatal care. More patients in the No-Dx group were admitted with cervical dilation >4cm (39.4% vs. 27.0%, p = 0.004), whereas 17.1% of patients in the Dx group were admitted for elective cesarean delivery at term. There was a higher cesarean delivery rate in the Dx group (64.1% vs. 50.8 %, p = 0.003), specifically for arrest disorders (15.2% vs. 6.9%, p = 0.008). The neonatal outcome in the two groups was similar regarding Apgar scores, intensive care nursery admission, need for mechanical ventilation, neonatal death, and length of nursery stay. Conclusions. Antepartum diagnosis of breech presentation decreases the threshold for cesarean delivery. Failure to diagnose breech antepartum does not compromise neonatal outcome.