MODE OF DELIVERY AND NEONATAL DEATH IN 17587 INFANTS PRESENTING BY THE BREECH

Objective - To study the effects of caesarean section on neonatal mortality in infants presenting by the breech. Design - Population-based non-experimental comparison of infants presenting by the breech born vaginally with those born by caesarean section. Neonatal mortality rates were calculated for 250 g birthweight intervals. Weight-specific relative risks (RRs) were further adjusted for birthweight in 50 g categories. Setting - New York City, 1978-1983. Data came from the Department of Health's computerized vital records on livebirths and infant deaths. Subjects - 17 587 singleton breech livebirths greater-than-or-equal-to 500 g birthweight, with congenital anomaly deaths excluded. 6178 were born vaginally and 11409 were born by caesarean section. Main outcome measures - Birthweight-specific and birthweight-adjusted neonatal mortality. Results - At birthweights of 501 to 1750 g, the risk of neonatal death for breech infants born vaginally was significantly higher than the risk for those born by caesarean section (weight-adjusted RR = 1.7). For breech infants with birthweights over 3000 g, the weight-adjusted risk was 5.6 times greater for a vaginal birth compared with caesarean section. The addition of 16 additional control variables in multiple logistic regression analyses did not change these RRs. Conclusion - Population-based studies indicate that an increase in the caesarean section rate among breech singletons may be associated with increased neonatal survival, but a large multicentre randomized trial of management of breech presentation would answer the question much more definitively.