IJE Advance Access published online on October 31, 2008
International Journal of Epidemiology, doi:10.1093/ije/dyn225
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Time trend in the risk of delivery-related perinatal and neonatal death associated with breech presentation at term
1 Department of Obstetrics and Gynaecology, Cambridge University, Cambridge CB2 2QQ, UK.
2 Department of Public Health and Primary Care, Cambridge University, Cambridge CB1 8RN, UK.
3 Public Health Section, University of Glasgow, Glasgow G12 8RZ, UK.
4 Information and Statistics Division, Common Services Agency, Edinburgh EH5 3SE, UK.
5 Department of Obstetrics and Gynaecology, University of Cambridge, NIHR Cambridge Comprehensive Biomedical Research Centre, Cambridge CB2 2QQ, UK.
* Corresponding author. Cambridge University, Rosie Maternity Hospital, Cambridge CB2 2SW, UK. E-mail: gcss2{at}cam.ac.uk
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Abstract |
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Background To determine the factors associated with the risk of delivery-related perinatal and neonatal death among term infants presenting by the breech and the effect of changes in the mode of delivery on the overall rates of perinatal and neonatal mortality associated with breech presentation.
Methods We studied 32 776 singleton term infants presenting breech excluding anomalous and antepartum losses in Scotland between 1985 and 2004, using linked Scottish national registries of pregnancy outcome data and perinatal death data. The event was delivery-related perinatal and neonatal death (i.e. intrauterine fetal death during labour or death of infant in the first 4 weeks of life), subdivided according to intrapartum anoxia or mechanical cause of death. Analysis was by multivariate logistic regression.
Results During the study period, the risk of delivery-related perinatal and neonatal death decreased by 72% (95% CI –1% to 93%), due to a 90% (95% CI 33–99%) reduction in anoxic or mechanical deaths. Both intrapartum (OR 0.16, 95% CI 0.02–0.75) and planned (OR 0.01, 95% CI 0.00–0.09) caesarean delivery were protective against anoxic or mechanical deaths and increased use of planned caesarean delivery accounted for 16% of the decline in anoxic and mechanical deaths over the study period.
Conclusion Increased use of planned caesarean delivery only partly explains the decline in delivery-related perinatal and neonatal death between 1985 and 2004 in Scotland.
Keywords Perinatal death, cause of death, time trends, breech pregnancies
Accepted 29 September 2008
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