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Delivery Outcomes in Subsequent Delivery Following Prior Breech Presentation
Abstract Number: F-33
Abstract Type: Original Research
Background: Breech presentation is a common indication for cesarean delivery (CD) (1). Alternatively, external cephalic version (ECV) may enable attempted vaginal delivery. We investigated delivery mode and maternal outcomes during subsequent deliveries following breech presentation, managed either by primary breech CD versus successful ECV.
Methods: We used the Labor and Delivery electronic medical record (EMR) to identify all women who underwent primary CD for breech presentation; and an ECV database to identify all women who had successful ECV for breech presentation, in one tertiary medical center, 2003-2013. The identified cases of primary breech CD and successful ECV were designated as the index delivery cohort (n=815); women with prior CD were excluded. We identified subsequent deliveries among the index delivery cohort. Multivariable analysis was used to report subsequent maternal delivery outcomes adjusted for maternal age and parity, comparing primary breech CD versus successful ECV at the index breech presentation. Outcomes include subsequent cesarean delivery, adverse maternal complication composite, placental complications, hemorrhage, infection, and complications associated with vaginal delivery or CD.
Results. We report 560 women with primary breech CD and 877 subsequent deliveries; and 255 women with successful ECV and 582 subsequent deliveries. Among the 1459 subsequent deliveries, women were significantly more likely to undergo subsequent CD following primary breech CD versus successful ECV during the index breech presentation, adjusted Odds Ratio (OR) 4.0; 95% Confidence interval (CI) 2.7-5.9. The adjusted adverse maternal complication composite was significantly more likely to occur among women undergoing subsequent delivery following primary breech CD versus successful ECV, OR 1.6; 95% CI 1.2-2.2. Subsequent delivery outcomes following index primary breech CD versus successful ECV are presented in the Table.
Conclusions: Delivery mode for breech presentation with no prior CD may affect maternal outcome for subsequent deliveries. Primary breech CD is associated with higher likelihood of subsequent CD, and is associated with higher likelihood of complications, including infection. ECV may be a suitable management strategy for women with breech presentation who are planning further pregnancies, in order to reduce the likelihood of subsequent CD and associated complications.
1. Caughey Ab et al Am J Obstet Gynecol 2014;210:179-93