Is a breech presentation at term more frequent in women with a history of cesarean delivery?

Association des Utilisateurs de Dossiers Informatisés en Pédiatrie, Obstétrique et Gynécologie sentinel network, Lyon, France.
American journal of obstetrics and gynecology (Impact Factor: 4.7). 06/2008; 198(5):521.e1-6. DOI: 10.1016/j.ajog.2007.11.009
Source: PubMed


The purpose of this study was to determine whether breech presentation at term is more common among women with at least 1 previous cesarean delivery.
This historic cohort study (n = 84,688) included women with a singleton term pregnancy and at least 1 previous delivery. Results were expressed as crude relative risks and adjusted odds ratios.
While 2.46% of women had a fetus in breech presentation at term, 14.91% of women had had 1 or more previous cesareans. The relative risk of a breech presentation at term for women with a history of cesarean was 2.18 (95%CI: 1.98-2.39). It did not differ according to the number of previous cesareans. The logistic regression analysis took into account confounding factors including gestational age, maternal age, parity, birthweight, and oligohydramnios. The adjusted odds ratio was 2.12 (95%CI: 1.91-2.36).
Women with previous cesarean deliveries have a risk of breech presentation at term twice that of women with previous vaginal deliveries.

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Available from: Bernard Jacquetin, Feb 10, 2014
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    • "This network, created in 1994, comprises public and private maternity units from every region in France; they contribute individual data on mothers and infants for pooling and analysis. Earlier publications have described its objectives and the database [25,26]. At the time of this study, the database included 411,734 pregnancies from 1994 through 2008 from 233 participating maternity units. "
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    ABSTRACT: Background The number of infants with a birth weight > 97th percentile for gestational age has increased over the years. Although some studies have examined the interest of inducing labor for fetuses with macrosomia suspected in utero, only a few have analyzed this suspected macrosomia according to estimated weight at each gestational age. Most studies have focused principally on neonatal rather than on maternal (and still less on perineal) outcomes. The principal aim of this study was to assess whether a policy of induction of labor for women with a constitutionally large-for-gestational-age fetus might reduce the occurrence of severe perineal tears; the secondary aims of this work were to assess whether this policy would reduce either recourse to cesarean delivery during labor or neonatal complications. Methods This historical cohort study (n = 3077) analyzed records from a French perinatal database. Women without diabetes and with a cephalic singleton term pregnancy were eligible for the study. We excluded medically indicated terminations of pregnancy and in utero fetal deaths. Among the pregnancies with fetuses suspected, before birth, of being large-for-gestational-age, we compared those for whom labor was induced from ≥ 37 weeks to ≤ 38 weeks+ 6 days (n = 199) to those with expectant obstetrical management (n = 2878). In this intention-to-treat analysis, results were expressed as crude and adjusted relative risks. Results The mean birth weight was 4012 g ± 421 g. The rate of perineal lesions did not differ between the two groups in either primiparas (aRR: 1.06; 95% CI: 0.86-1.31) or multiparas (aRR: 0.94; 95% CI: 0.84-1.05). Similarly, neither the cesarean rate (aRR: 1.11; 95% CI: 0.82-1.50) nor the risks of resuscitation in the delivery room or of death in the delivery room or in the immediate postpartum or of neonatal transfer to the NICU (aRR = 0.94; 95% CI: 0.59-1.50) differed between the two groups. Conclusions A policy of induction of labor for women with a constitutionally large-for-gestational-age fetus among women without diabetes does not reduce maternal morbidity.
    BMC Pregnancy and Childbirth 05/2014; 14(1):156. DOI:10.1186/1471-2393-14-156 · 2.19 Impact Factor
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    • "Venditelli found the risk of breech presentation at term in women with previous cesarean deliveries to be twice that of women with previous vaginal deliveries [19] [21], but our data does not confirm these findings. "
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    ABSTRACT: Abstract Objective. Breech presentation represents a common indication for primary cesarean section in women presenting for parturition. This study aims to investigate the presence of new and old risk factors for breech presentation and to provide a literature review. Methods. In this population-based retrospective cohort study we collected data from 14'433 consecutive singleton deliveries occurred in a 3rd level hospital setting of northeast Italy between January 2001 and July 2009. Related risk factors and trends in breech presentation prevalence were also considered. Results. Mean maternal age was 31.78 years (±5.17) and mean gestational age at delivery 38.67 weeks (±2.54). Breech presentation prevalence in nullipara and pluripara was respectively 5.36% (415/7743) and 3.53% (236/6689) (p<0.05), and was significantly lower among Sub-Saharan-African women 2.62% (14/535) vs 4.51% (651/14432) (p<0.05). Also advanced maternal age, early gestational age at delivery, neonatal female gender and low weight at delivery resulted associated with a higher prevalence of breech presentation. By multivariate logistic regression, the breech presentation resulted independently predicted by maternal age, ethnicity, parity, gestational age and neonatal weight MoMs at delivery, and neonatal gender. Conclusions. Advanced maternal age, early gestational age, low neonatal weight MoMs at delivery and female gender resulted to be risk factors for fetal breech presentation at delivery, while multiparity and Sub-Saharan-African ethnicity resulted to be protective.
    The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 05/2013; 27(2). DOI:10.3109/14767058.2013.806891 · 1.37 Impact Factor
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    ABSTRACT: This study evaluated the predictive factors and short-term fetal outcomes of breech presentation by comparing breech and cephalic pregnancies of >or=36 weeks gestation. Two hundred and one breech and 149 cephalic pregnancies of >or=36 weeks gestation, with no other maternal or fetal problems, were compared with regard to placental localization, fetal heart rate variability, smoking, body mass index, maternal weight gain, placental weight, birth weight, sex, Apgar scores, and umbilical cord length. Maternal weight gain, body mass index at term, smoking and hemoglobin values were significantly higher in breech presentation than in cephalic pregnancies. The placenta was located in the cornu-fundal region in 63.2% of breech presentations and 26.8% of cephalic presentations (p<0.001). Placental weights were 657 g and 597 g, respectively (p<0.001). Umbilical cord length was shorter in breech than cephalic pregnancies (p<0.001). Although breech pregnancies had significantly reduced fetal heart rate variability (p<0.001), Apgar scores were much higher in breech fetuses than in cephalic fetuses. Ninety-five percent of breech pregnancies underwent cesarean sections. Cornu-fundal localization of the placenta, smoking, greater maternal weight gain, higher body mass index at term, greater placental weight, shorter umbilical cord, and lower estimated fetal weight may be predictive of persistent breech presentation. Reduced fetal heart rate variability did not have an adverse effect on Apgar scores after cesarean delivery in breech fetuses with no other problems at term.
    Taiwanese journal of obstetrics & gynecology 12/2008; 47(4):402-7. DOI:10.1016/S1028-4559(09)60006-1 · 0.99 Impact Factor
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