Abstract
Author(s): Vjosa A. Zejnullahu and Valon A. Zejnullahu*
Objective: The aim of the present study was to compare short-term maternal and neonatal outcomes in breech presentations at term according to the planned mode of delivery.
Study design: A retrospective cohort study including 453 women with singleton term breech deliveries (37-42 weeks) registered at Obstetrics and Gynecology Clinic in Pristina, University Clinical Center of Kosovo from January 2019 to December 2020. The data were collected from the birth register and pediatric records. The main outcome measures were neonatal and maternal mortality and morbidity, compared according to the mode of delivery.
Results: For 217 women (47.9%) a vaginal delivery was planned, of whom 83 (18.3%) were delivered vaginally. In 236 (52.1%) cases elective cesarean section was performed as planned. 134 (29.5%) were delivered by emergent cesarean section. Difference in mothers age between the three groups was statistically significant (p=0.011). Nulliparous women were more common in the elective cesarean group compared to planned vaginal group (35.5% vs. 5.96%; p < 0.0001). We found a statistically significant association between the maternal comorbidities and vaginal group vs. elective cesarean group (0.6% vs. 4.8%; p=0.015). The mean gestational age at birth was significantly lower in the vaginal delivery group (37.8 weeks vs. 38.4 weeks; p<0.0001) as was the mean birth weight (3285 g vs. 3925 g; p<0.0001). The mean Apgar scores at one minute were lower in the planned vaginal group compared with the cesarean delivery groups (6.7 vs. 8.5 vs. 8.6; p<0.0001). Admission to the NICU was significantly higher in the vaginal delivery group compared to the elective and emergent cesarean section group (2.8% vs. 0.8% vs. 1.1%; p<0.0001) as was neonatal birth trauma (0.6 vs. 0.00 vs. 0.00; p=0.006). Elective cesarean delivery is associated with significantly reduced likelihood of fetal complications (OR=0.085, 95% CI: 0.027-0.270, p<0.0001), than the planned vaginal delivery. Statistically insignificant increase of maternal postpartum morbidity was also registered.
Conclusion: Elective cesarean birth for term-breech infants is associated with a clinically significant decrease in perinatal morbidity and mortality and with insignificant increase in short-term maternal morbidity, compared with planned vaginal birth.