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Morbidity and mortality associated with mode of delivery for breech periviable deliveries
- Publication Year :
- 2015
-
Abstract
- The purpose of this study was to estimate the odds of morbidity and death that are associated with cesarean delivery, compared with vaginal delivery, for breech fetuses who are delivered from 23-24 6/7 weeks' gestational age.We conducted a retrospective cohort study of state-level maternal and infant hospital discharge data that were linked to vital statistics for breech deliveries that occurred from 23-24 6/7 weeks' gestation in California, Missouri, and Pennsylvania from 2000-2009 (N = 1854). Analyses were stratified by gestational age (23-23 6/7 vs 24-24 6/7 weeks' gestation).Cesarean delivery was performed for 46% (335 fetuses) and 77% (856 fetuses) of 23- and 24-week breech fetuses. In multivariable analyses, overall survival was greater for cesarean-born neonates (adjusted odds ratio [AOR], 3.98; 95% confidence interval [CI], 2.24-7.06; AOR, 2.91; 95% CI, 1.76-4.81, respectively). When delivered for nonemergent indications, cesarean-born survivors were more than twice as likely to experience major morbidity (intraventricular hemorrhage, bronchopulmonary dysplasia, necrotizing enterocolitis, asphyxia composite; AOR, 2.83; 95% CI, 1.37-5.84; AOR, 2.07; 95% CI, 1.11-3.86 at 23 and 24 weeks' gestation, respectively). Among intubated neonates, despite a short-term survival advantage, there was no difference in survival to6-month corrected age (AOR, 1.77; 95% CI, 0.83-3.74; AOR, 1.50; 95% CI, 0.81-2.76, respectively). There was no difference in survival for intubated 23-week neonates who were delivered by cesarean for nonemergent indications or cesarean-born neonates who weighed500 g.Cesarean delivery increased overall survival and major morbidity for breech periviable neonates. However, among intubated neonates, despite a short-term survival advantage, there was no difference in 6-month survival. Also, cesarean delivery did not increase survival for neonates who weighed500 g. Patients and providers should discuss explicitly the trade-offs related to neonatal death and morbidity, maternal morbidity, and implications for future pregnancies.
- Subjects :
- Adult
Pediatrics
medicine.medical_specialty
Adolescent
Article
Young Adult
Enterocolitis, Necrotizing
Pregnancy
Breech presentation
medicine
Humans
Breech Presentation
Fetal Death
reproductive and urinary physiology
Survival analysis
Bronchopulmonary Dysplasia
Cerebral Hemorrhage
Asphyxia
Asphyxia Neonatorum
Cesarean Section
Vaginal delivery
business.industry
Infant, Newborn
Obstetrics and Gynecology
Gestational age
Retrospective cohort study
Delivery, Obstetric
medicine.disease
Survival Analysis
Bronchopulmonary dysplasia
Female
Morbidity
medicine.symptom
business
Subjects
Details
- Language :
- English
- ISSN :
- 20002009
- Database :
- OpenAIRE
- Accession number :
- edsair.doi.dedup.....a14325ee259c9f358c31430ded4cff9c