Is vaginal delivery of a fetus in breech presentation at an extremely preterm gestational age associated with an increased risk of neonatal death? A comparative study.

<h4>Background</h4>The effect on neonatal mortality of mode of delivery of a fetus in breech presentation at an extremely preterm gestational age remains controversial.<h4>Objective</h4>To compare mortality associated with planned vaginal delivery (PVD) of fetuses in breech p...

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Autores principales:	Clémentine Pierre, Audrey Leroy, Adeline Pierache, Laurent Storme, Véronique Debarge, Sandrine Depret, Thameur Rakza, Charles Garabedian, Damien Subtil
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/2514c890144a443a903cd80bbb568448
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spelling	oai:doaj.org-article:2514c890144a443a903cd80bbb5684482021-12-02T20:13:37ZIs vaginal delivery of a fetus in breech presentation at an extremely preterm gestational age associated with an increased risk of neonatal death? A comparative study.1932-620310.1371/journal.pone.0258303https://doaj.org/article/2514c890144a443a903cd80bbb5684482021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0258303https://doaj.org/toc/1932-6203<h4>Background</h4>The effect on neonatal mortality of mode of delivery of a fetus in breech presentation at an extremely preterm gestational age remains controversial.<h4>Objective</h4>To compare mortality associated with planned vaginal delivery (PVD) of fetuses in breech presentation with that of fetuses in breech presentation with a planned cesarean delivery (PCD).<h4>Material and methods</h4>Retrospective study reviewing records over a 19-year period in a level 3 university referral center of singleton infants born between 25+0 and 27+6 weeks of gestation, alive on arrival in the delivery room, and weighing at least 500 grams at birth. Infants in the first group were in breech presentation with PVD and the second in breech presentation with PCD. The principal endpoint was neonatal death.<h4>Results</h4>During the study period, we observed 113 breech presentations with PVD, and 80 breech presentations with PCD. Although not significant after adjustment, neonatal mortality in the breech PVD group was more than twice that of the breech PCD group (19.5 vs 7.8%, P = 0.031, ORa = 2.6, 95% CI 0.8-9.3, NNT = 8). This higher neonatal mortality in the breech PVD group was exclusively associated with a higher risk of death in the delivery room (12.4 vs 0.0% P = 0.001, OR not calculable, NNT = 8). In these extremely preterm breech presentations with PVD, neonatal mortality in the delivery room was associated with entrapment of the aftercoming head, cord prolapse, and a short duration of labor.<h4>Conclusion</h4>For deliveries between 25+0 and 27+6 weeks' gestation, vaginal delivery in breech presentation is associated with a higher risk of death in the delivery room.Clémentine PierreAudrey LeroyAdeline PieracheLaurent StormeVéronique DebargeSandrine DepretThameur RakzaCharles GarabedianDamien SubtilPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 10, p e0258303 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Clémentine Pierre Audrey Leroy Adeline Pierache Laurent Storme Véronique Debarge Sandrine Depret Thameur Rakza Charles Garabedian Damien Subtil Is vaginal delivery of a fetus in breech presentation at an extremely preterm gestational age associated with an increased risk of neonatal death? A comparative study.
description	<h4>Background</h4>The effect on neonatal mortality of mode of delivery of a fetus in breech presentation at an extremely preterm gestational age remains controversial.<h4>Objective</h4>To compare mortality associated with planned vaginal delivery (PVD) of fetuses in breech presentation with that of fetuses in breech presentation with a planned cesarean delivery (PCD).<h4>Material and methods</h4>Retrospective study reviewing records over a 19-year period in a level 3 university referral center of singleton infants born between 25+0 and 27+6 weeks of gestation, alive on arrival in the delivery room, and weighing at least 500 grams at birth. Infants in the first group were in breech presentation with PVD and the second in breech presentation with PCD. The principal endpoint was neonatal death.<h4>Results</h4>During the study period, we observed 113 breech presentations with PVD, and 80 breech presentations with PCD. Although not significant after adjustment, neonatal mortality in the breech PVD group was more than twice that of the breech PCD group (19.5 vs 7.8%, P = 0.031, ORa = 2.6, 95% CI 0.8-9.3, NNT = 8). This higher neonatal mortality in the breech PVD group was exclusively associated with a higher risk of death in the delivery room (12.4 vs 0.0% P = 0.001, OR not calculable, NNT = 8). In these extremely preterm breech presentations with PVD, neonatal mortality in the delivery room was associated with entrapment of the aftercoming head, cord prolapse, and a short duration of labor.<h4>Conclusion</h4>For deliveries between 25+0 and 27+6 weeks' gestation, vaginal delivery in breech presentation is associated with a higher risk of death in the delivery room.
format	article
author	Clémentine Pierre Audrey Leroy Adeline Pierache Laurent Storme Véronique Debarge Sandrine Depret Thameur Rakza Charles Garabedian Damien Subtil
author_facet	Clémentine Pierre Audrey Leroy Adeline Pierache Laurent Storme Véronique Debarge Sandrine Depret Thameur Rakza Charles Garabedian Damien Subtil
author_sort	Clémentine Pierre
title	Is vaginal delivery of a fetus in breech presentation at an extremely preterm gestational age associated with an increased risk of neonatal death? A comparative study.
title_short	Is vaginal delivery of a fetus in breech presentation at an extremely preterm gestational age associated with an increased risk of neonatal death? A comparative study.
title_full	Is vaginal delivery of a fetus in breech presentation at an extremely preterm gestational age associated with an increased risk of neonatal death? A comparative study.
title_fullStr	Is vaginal delivery of a fetus in breech presentation at an extremely preterm gestational age associated with an increased risk of neonatal death? A comparative study.
title_full_unstemmed	Is vaginal delivery of a fetus in breech presentation at an extremely preterm gestational age associated with an increased risk of neonatal death? A comparative study.
title_sort	is vaginal delivery of a fetus in breech presentation at an extremely preterm gestational age associated with an increased risk of neonatal death? a comparative study.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/2514c890144a443a903cd80bbb568448
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Is vaginal delivery of a fetus in breech presentation at an extremely preterm gestational age associated with an increased risk of neonatal death? A comparative study.

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