Is breech presentation a risk factor for cerebral palsy? A Norwegian birth cohort study.
ABSTRACT To study whether breech presentation is a risk factor for cerebral palsy (CP).
Perinatal data from 177 272 children born in breech or vertex presentation in Norway during 1996 to 1998 were retrieved from the Medical Birth Registry of Norway. Data were collected between 1 January 2003 and 31 March 2006. Data on 245 children with CP were recorded in the Norwegian Cerebral Palsy Registry. Odds ratios (OR) with 95% confidence intervals (CI) for CP among children born in breech compared with vertex presentation were calculated. Confounding was addressed in logistic regression and stratified analyses.
Among the 245 children with CP (46.5% females and 53.5% males), 31% had unilateral, 49% bilateral, 7% dyskinetic, and 5% the ataxic subtype, and 8% of cases were unclassified. Among children born in breech, the OR for CP was 3.6 (95% CI 2.4-5.3). The increased risk was reduced when adjusted for preterm birth, plurality, and smallness for gestational age. Among singletons born in breech by vaginal delivery at term, the OR for CP was 3.9 (95% CI 1.6-9.7). Severity or subtype of CP did not differ between breech and vertex presentation.
Breech delivery is a significant risk factor for CP, in particular among singletons born by vaginal delivery at term.
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ABSTRACT: To provide an overview of current research on risk factors for cerebral palsy (CP) in children born at term and hypothesize how new findings can affect the content of the CP registers worldwide. A systematic search in PubMed for original articles, published from 2000 to 2010, regarding risk factors for CP in children born at term was conducted. Full text review was made of 266 articles. Factors from the prenatal, perinatal and neonatal period considered as possible contributors to the causal pathway to CP in children born at term were regarded as risk factors. Sixty-two articles met the criteria for an original report on risk factors for CP in children born at term. Perinatal adverse events, including stroke, were the focus of most publications, followed by genetic studies. Malformations, infections, perinatal adverse events and multiple gestation were risk factors associated with CP. The evidence regarding, for example, thrombophilic factors and non-CNS abnormalities was inconsistent. Information on maternal and neonatal infections, umbilical cord blood gases at birth, mode of delivery and placental status should be collected in a standardized way in CP registers. Information on social factors, such as education level, family income and area of residence, is also of importance. More research is needed to understand the risk factors of CP and specifically how they relate to causal pathways of cerebral palsy.Acta Obstetricia Et Gynecologica Scandinavica 06/2011; 90(10):1070-81. · 1.85 Impact Factor
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ABSTRACT: To investigate the association between labor induction and later development of cerebral palsy (CP). Registry-based cohort study. Perinatal data on all children born in Norway 1996-1998 were obtained from the Medical Birth Registry of Norway (MBRN). Neurodevelopmental data were collected from the Norwegian Cerebral Palsy Registry (CPRN). A total of 176,591 children surviving the neonatal period. Of 373 children with CP, detailed data were available on 241. Unadjusted and adjusted odds ratios (OR) with 95% confidence intervals (CI) were calculated as estimates of the relative risk that a child with CP was born after labor induction. Total CP and spastic CP subtypes. Bilateral cerebral palsy was more frequently observed after induced labor (OR: 3.1; 95% CI 2.1-4.5). For children born at term the association between bilateral CP and labor induction was stronger (OR: 4.4; 95% CI 2.3-8.6). The association persisted after adjustment for maternal disease, gestational age, standard deviation score for birthweight (z-score) and prelabor rupture of membranes (PROM) (adjusted OR: 3.7; 95%CI 1.8-7.5). Among children with CP born at term, four-limb involvement (quadriplegia) was significantly more frequent after induced (45.5%) compared with non-induced labor (8.0%). There was no significant association between labor induction and unilateral CP subtype or CP in preterm born children. In this study population, we found that labor induction at term was associated with excess risk of bilateral spastic CP and in particular CP with four-limb involvement.Acta Obstetricia Et Gynecologica Scandinavica 01/2011; 90(1):83-91. · 1.85 Impact Factor
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ABSTRACT: To analyze the consequences of the handling of breech presentation in Denmark after publication of the Term Breech Trial (TBT). Population-based retrospective cohort study. Data from the National Birth Registry and discharge letters from cases with perinatal death. Population. Singleton breech fetuses at term and alive at onset of labor delivered between 1997 and 2008 (n=23 789). Outcomes before and after publication of TBT were compared and analyzed by planned mode of delivery. Cesarean section, intrapartum or early neonatal mortality in infants without lethal congenital malformations, Apgar score ≤ 6 at five minutes and admittance to neonatal intensive care unit (NICU) for four days or more. The rate of cesarean section increased from 79.6 to 94.2%. Intrapartum or early neonatal mortality was reduced from 0.13 to 0.05%[relative risk (RR) 0.38 (95% confidence intervals (CI) 0.15-0.98)]. The incidence of low Apgar scores declined from 1.0 to 0.6%[RR 0.83 (95%CI 0.73-0.95)] and admission to NICU from 4.2 to 3.2%[RR 0.92 (95%CI 0.87-0.97)]. Planned vaginal delivery was associated with an increased risk of mortality, low Apgar score and admission to NICU throughout the period. Reduction in the rate of vaginal delivery was correlated with a significant reduction in rates of intrapartum or early neonatal mortality and morbidity, but at a much lower level than reported in the Term Breech Trial. The lower rate of vaginal delivery, indicating a strict selection of women, did not reduce the relative risks of complications during a planned vaginal delivery.Acta Obstetricia Et Gynecologica Scandinavica 07/2011; 90(7):767-71. · 1.85 Impact Factor