Changes in the rates of caesarean delivery before labour for breech presentation at term in France: 1972-2003

Objective: To describe the changes in the rate of caesarean deliveries before labour among women with term breech presentations in France and to identify the factors associated with this change over two periods: 1972-1995/1998 and 1995/1998-2003. Population: The study population consisted of 1479 women with a foetus in a breech presentation at term and without any previous caesarean delivery, from the population of births in the 1972, 1995, 1998 and 2003 national perinatal surveys (N = 53 136). Data from the 1995 and 1998 surveys were pooled. Methods: The principal endpoint was caesarean delivery before labour. Associations between the factors studied and caesarean before labour were estimated by odds ratios, both crude and adjusted with a logistic regression model. Results: Between 1972 and 2003, the rate of caesareans before labour for women with term breech presentations rose sharply (from 14.5% in 1972 to 42.6% in 1995/1998 and to 74.5% in 2003). Between 1972 and 1995/1998, this increase was especially marked among the nulliparous women (16.7% versus 52.9%). From 1995/1998 to 2003, the increase was greatest for multiparas: in 2003 this rate among women with children was close to that for women who had never given birth (64.5% and 79.5%, respectively). After adjustment, the factors associated with a high rate of caesarean before labour were nulliparity, birth between 38 and 40 weeks' gestation, birth weight >= 3800 g, delivery in the private sector and year of delivery. The rate of caesareans before labour was significantly higher in 2003 (ORa = 19.04 [12.06-30.06]) and in 19951998 (ORa = 4.30 [2.87-6.47]) than in 1972. Conclusion: The increase in the rate of caesarean deliveries before labour in women with term breech presentations was associated principally with changes in obstetrical practices. (c) 2006 Elsevier Ireland Ltd. All rights reserved.