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Risk factors for emergency caesarean section in planned vaginal breech delivery

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To identify risk factors for emergency caesarean section in women attempting a vaginal breech delivery at term.

Methods

Data from 1092 breech deliveries performed between 1998 and 2013 at a Swiss cantonal hospital were extracted from an electronic database. Of the 866 women with a singleton, full term pregnancy, 464 planned a vaginal breech delivery. Fifty-seven percent (265/464) were successful in delivering vaginally. Multivariate regression analyses of risk factors were performed, and neonatal and maternal complications were compared.

Results

Risk factors for failed vaginal delivery were peridural anaesthesia (OR 2.05; 95 % CI 1.09–3.84; p = 0.025), nulliparity (OR 2.82; 95 % CI 1.87–4.25; p < 0.001), high birth weight (OR 1.17; 95 % CI 1.04–1.30; p = 0.006) and induction of labour (OR 1.56; 95 % CI 1.003–2.44; p = 0.048). Maternal age, height and weight; gestational age; or newborn length and head circumference were not associated with an unplanned caesarean section. The rate of successful vaginal delivery in the low risk sub-group (multiparous women without induction of labour) was 58–83 %, depending on birth weight category. The likelihood of success for the high risk sub-group (nulliparous women with induction of labour) fell below a third at neonatal birth weights >3250 g. Complication rates were low in the cohort.

Conclusions

Use of peridural anaesthesia, nulliparity, high birth weight and induction of labour were risk factors for unsuccessful vaginal breech delivery requiring an unplanned caesarean section. Awareness of these risk factors is useful when counselling women who are considering a vaginal breech delivery.

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Acknowledgments

The authors wish to thank JoEllen Welter for copy-editing the manuscript.

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Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, Cantonal Hospital Frauenfeld, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland

    Tamara K. Parissenti, Gundula Hebisch, Wieland Sell, Patricia E. Staedele, Volker Viereck & Mathias K. Fehr

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  1. Tamara K. Parissenti
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  2. Gundula Hebisch
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  3. Wieland Sell
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  4. Patricia E. Staedele
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  5. Volker Viereck
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Corresponding author

Correspondence to Mathias K. Fehr.

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Conflict of interest

T. Parissenti declares that she has no conflict of interest. G. Hebisch declares that she has no conflict of interest. W. Sell declares that he has no conflict of interest. P. Staedele declares that she has no conflict of interest. V. Viereck declares that he has no conflict of interest. M. Fehr declares that he has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

An exemption to obtain written consent from all individuals of this retrospective chart analysis was granted by the local ethics committee.

The authors had full control of all primary data and agree to allow the Journal to review the data if requested.

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Parissenti, T.K., Hebisch, G., Sell, W. et al. Risk factors for emergency caesarean section in planned vaginal breech delivery. Arch Gynecol Obstet 295, 51–58 (2017). https://doi.org/10.1007/s00404-016-4190-y

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  • DOI: https://doi.org/10.1007/s00404-016-4190-y

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