Outcome of small for gestational age-fetuses in breech presentation at term according to mode of delivery: a nationwide, population-based record linkage study

  • Pia Hinnenberg
  • Anna Toijonen
  • Mika Gissler
  • Seppo Heinonen
  • Georg MachareyEmail author
Maternal-Fetal Medicine



To evaluate whether a trial of planned vaginal labor is associated with adverse perinatal outcome in singleton, small for gestational agefetuses in breech presentation at term.


This is a Finnish nationwide, population-based record linkage study. The studied population included all small for gestational age breech labors from January 1, 2004 to December 31, 2014. “Small for gestational age” was defined as birth weight below the 10th percentile according to gestational age. An odds ratio with 95% confidence intervals was used to estimate the relative risk for perinatal mortality and morbidity in a trial of vaginal labor. The reference group included all small for gestational age infants born in breech presentation by planned cesarean section.


During the study period of eleven years, 1841 small for gestational age infants were delivered in breech position at term. A trial of vaginal breech labor is associated with a higher rate of neonates with an umbilical pH below seven [odds ratio 7.82 (1–61.21)], a lower 5-min Apgar score < 7 [adjusted odds ratio 6.39 (1.43–28.46)] and < 4 [adjusted odds ratio 6.39 (1.43–28.46)], a higher rate of postpartum neonatal intubations [adjusted odds ratio 6.52 (1.93–22)], an increased rate of neonatal antibiotic therapy [adjusted odds ratio 3.31 (1.85–5.93)], and with a higher rate of combined severe adverse perinatal outcome [adjusted odds ratio 4.24 (1.43–12.61)].


A trial of vaginal breech labor in SGA fetuses is associated with adverse perinatal outcome and should be avoided.


Breech Small for gestational age SGA Mortality Morbidity Term 


Author contribution

PH project development, data management, manuscript writing. AT project development, data management, manuscript writing. SH project development, data management, manuscript writing and editing. MG data collection, data management, data analysis, manuscript editing. GM project development, data management, manuscript writing and editing.


The study did not have external funding.

Compliance with ethical standards

Conflict of interest

The authors state explicitly that there are no conflicts of interest in connection with this article. All authors declare independence from any funding agency for this work.

Ethical statement

Authorization to use the data was obtained from the National Institute for Health and Welfare as required by the national data protection legislation law in Finland (reference number THL/1200/5.05.00/2012).


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyUniversity of Helsinki, Helsinki University Hospital, HUSHelsinkiFinland
  2. 2.National Institute for Health and Welfare (THL)HelsinkiFinland

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