Journal
INTERNATIONAL JOURNAL OF GYNECOLOGY & OBSTETRICS
Volume 161, Issue 1, Pages 17-25Publisher
WILEY
DOI: 10.1002/ijgo.14483
Keywords
breech presentation; cesarean delivery; infant mortality; lower-middle-income countries; low-income countries; pregnancy outcome
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This study assessed the impact of singleton vaginal breech delivery (VBD) and cesarean breech delivery (CBD) on neonatal and maternal mortality and morbidity in low- and lower-middle-income settings. The results showed that VBD increased the risk of perinatal mortality and 5-minute Apgar score below 7 compared to CBD. On the other hand, CBD was associated with a higher risk of hospitalization and postpartum bleeding.
Most studies comparing vaginal breech delivery (VBD) with cesarean breech delivery (CBD) have been conducted in high-income settings. It is uncertain whether these results are applicable in a low-income setting. To assess the neonatal and maternal mortality and morbidity for singleton VBD compared to CBD in low- and lower-middle-income settings,the PubMed database was searched from January 1, 2000, to January 23, 2020 (updated April 21, 2021). Randomized controlled trials (RCTs) and non-RCTs comparing singleton VBD with singleton CBD in low- and lower-middle-income settings reporting infant mortality were selected. Two authors independently assessed papers for eligibility and risk of bias. The primary outcome was relative risk of perinatal mortality. Meta-analysis was conducted on applicable outcomes. Eight studies (one RCT, seven observational) (12 510 deliveries) were included. VBD increased perinatal mortality (relative risk [RR] 2.67, 95% confidence interval [CI] 1.82-3.91; one RCT, five observational studies, 3289 women) and risk of 5-minute Apgar score below 7 (RR 3.91, 95% CI 1.90-8.04; three observational studies, 430 women) compared to CBD. There was a higher risk of hospitalization and postpartum bleeding in CBD. Most of the studies were deemed to have moderate or serious risk of bias. CBD decreases risk of perinatal mortality but increases risk of bleeding and hospitalization.
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