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Delivery mode by race for breech presentation in the US

Journal of Perinatology volume 27, pages 147–153 (2007)Cite this article

Abstract

Objective:

To determine if there are differential cesarean delivery rates by race and other socio-demographic factors for women with breech infants.

Study Design:

We calculated cesarean delivery rates for 186 727 White, African American, Hispanic and Asian women delivering breech singletons with gestational age 26 to 41 weeks born in 1999 and 2000 using data from the National Center for Health Statistics. Multivariable logistic regression was used to determine differences in mode of delivery by race, adjusting for socio-demographic and medical factors.

Results:

Cesarean rates for breech were >80% in most gestational age groups. In 14 of 18 groups, Whites had higher cesarean delivery rates than African Americans. However, this finding did not persist after risk adjustment. Hispanics were more likely to deliver by cesarean delivery than African Americans and Whites.

Conclusion:

Breech singleton infants are predominantly born by cesarean delivery. Although African-American women with breech presentation have lower cesarean delivery rates than Whites, this difference is not present after adjusting for socio-demographic and medical factors. Hispanics were more likely to be delivered by cesarean delivery and this difference was amplified after risk adjustment. Asians had slightly lower cesarean rates after risk adjustment, but this varied widely according to Asian subgroup.

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References

  1. Hannah ME, Hannah WJ, Hewson SA, Hodnett ED, Saigal S, Willan AR . Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Term Breech Trial Collaborative Group. Lancet 2000; 356 (9239): 1375–1383.

    Article  CAS  Google Scholar 

  2. Alexandersson O, Bixo M, Hogberg U . Evidence-based changes in term breech delivery practice in Sweden. Acta Obstet Gynecol Scand 2005; 84 (6): 584–587.

    Article  Google Scholar 

  3. Rietberg CC, Elferink-Stinkens PM, Visser GH . The effect of the Term Breech Trial on medical intervention behavior and neonatal outcome in The Netherlands: an analysis of 35,453 term breech Infants. Obstet Gynecol Surv 2005; 60 (5): 289–290.

    Article  Google Scholar 

  4. ACOG Committee Opinion No 340. Mode of term singleton breech delivery. Obstet Gynecol 2006; 108 (1): 235–237.

  5. Lee KS, Khoshnood B, Sriram S, Hsieh HL, Singh J, Mittendorf R . Relationship of cesarean delivery to lower birth weight-specific neonatal mortality in singleton breech infants in the United States. Obstet Gynecol 1998; 92 (5): 769–774.

    CAS  PubMed  Google Scholar 

  6. Main DM, Main EK, Maurer MM . Cesarean section versus vaginal delivery for the breech fetus weighing less than 1,500 grams. Am J Obstet Gynecol 1983; 146 (5): 580–584.

    Article  CAS  Google Scholar 

  7. Gorbe E, Chasen S, Harmath A, Patkos P, Papp Z . Very-low-birthweight breech infants: short-term outcome by method of delivery. J Matern Fetal Med 1997; 6 (3): 155–158.

    Article  CAS  Google Scholar 

  8. Granati B, Rondinelli M, Capoti C, Carnielli V, Bottos M, Rubaltelli FF . The premature breech presentation: outcome of newborn infants born by vaginal or abdominal delivery. Am J Perinatol 1984; 1 (2): 145–147.

    Article  CAS  Google Scholar 

  9. Weissman A, Blazer S, Zimmer EZ, Jakobi P, Paldi E . Low birthweight breech infant: short-term and long-term outcome by method of delivery. Am J Perinatol 1988; 5 (3): 289–292.

    Article  CAS  Google Scholar 

  10. Lumley J, Lester A, Renou P, Wood C . A failed RCT to determine the best method of delivery for very low birth weight infants. Control Clin Trials 1985; 6 (2): 120–127.

    Article  CAS  Google Scholar 

  11. Penn ZJ, Steer PJ, Grant A . A multicentre randomised controlled trial comparing elective and selective caesarean section for the delivery of the preterm breech infant. Br J Obstet Gynaecol 1996; 103 (7): 684–689.

    Article  CAS  Google Scholar 

  12. Zlatnik FJ . The Iowa premature breech trial. Am J Perinatol 1993; 10 (1): 60–63.

    Article  CAS  Google Scholar 

  13. Healthy People 2010: Understanding and Improving Health. 2nd ed. US Department of Health and Human Services. US Government Printing Office, Washington, DC; 2000.

  14. Braveman P, Egerter S, Edmonston F, Verdon M . Racial/ethnic differences in the likelihood of cesarean delivery, California. Am J Public Health 1995; 85 (5): 625–630.

    Article  CAS  Google Scholar 

  15. Hamvas A, Wise PH, Yang RK, Wampler NS, Noguchi A, Maurer MM et al. The influence of the wider use of surfactant therapy on neonatal mortality among blacks and whites. N Engl J Med 1996; 334 (25): 1635–1640.

    Article  CAS  Google Scholar 

  16. Ranganathan D, Wall S, Khoshnood B, Singh JK, Lee KS . Racial differences in respiratory-related neonatal mortality among very low birth weight infants. J Pediatr 2000; 136 (4): 454–459.

    Article  CAS  Google Scholar 

  17. Bickell NA, Wang JJ, Oluwole S, Schrag D, Godfrey H, Hiotis K et al. Missed opportunities: racial disparities in adjuvant breast cancer treatment. J Clin Oncol 2006; 24 (9): 1357–1362.

    Article  Google Scholar 

  18. Mallinger JB, Fisher SG, Brown T, Lamberti JS . Racial disparities in the use of second-generation antipsychotics for the treatment of schizophrenia. Psychiatr Serv 2006; 57 (1): 133–136.

    Article  Google Scholar 

  19. Hertz RP, Unger AN, Cornell JA, Saunders E . Racial disparities in hypertension prevalence, awareness, and management. Arch Intern Med 2005; 165 (18): 2098–2104.

    Article  Google Scholar 

  20. Bertoni AG, Goonan KL, Bonds DE, Whitt MC, Goff Jr DC, Brancati FL . Racial and ethnic disparities in cardiac catheterization for acute myocardial infarction in the United States 1995–2001. Natl Med Assoc 2005; 97 (3): 317–323.

    Google Scholar 

  21. National Center for Health Statistics. 1999 to 2000 Birth Cohort Linked Birth and Infant Death Data Set. Hyattsville, MD: National Center for Health Statistics; 2001.

  22. Kotelchuck M . An evaluation of the Kessner adequacy of prenatal care index and a proposed adequacy of prenatal care utilization index. Am J Public Health 1994; 84 (9): 1414–1420.

    Article  CAS  Google Scholar 

  23. National Center for Health Statistics. Technical Appendix from Vital Statistics of the United States 1999 Natality. Centers for Disease Control and Prevention Hyattsville, Maryland March 2001.

  24. National Center for Health Statistics. Technical Appendix from Vital Statistics of the United States 2000 Natality. Centers for Disease Control and Prevention Hyattsville, Maryland January 2002.

  25. ACOG committee opinion: number 265 December 2001. Mode of term single breech delivery. Obstet Gynecol 2001; 98 (6): 1189–1190.

  26. Krupitz H, Arzt W, Ebner T, Sommergruber M, Steininger E, Tews G . Assisted vaginal delivery versus caesarean section in breech presentation. Acta Obstet Gynecol Scand 2005; 84 (6): 588–592.

    Article  Google Scholar 

  27. Uotila J, Tuimala R, Kirkinen P . Good perinatal outcome in selective vaginal breech delivery at term. Acta Obstet Gynecol Scand 2005; 84 (6): 578–583.

    Article  Google Scholar 

  28. Alarab M, Regan C, O'Connell MP, Keane DP, O'Herlihy C, Foley ME . Singleton vaginal breech delivery at term: still a safe option. Obstet Gynecol 2004; 103 (3): 407–412.

    Article  Google Scholar 

  29. Whyte H, Hannah ME, Saigal S, Hannah WJ, Hewson S, Amankwah K et al. Outcomes of children at 2 years after planned cesarean birth versus planned vaginal birth for breech presentation at term: the International Randomized Term Breech Trial. Am J Obstet Gynecol 2004; 191 (3): 864–871.

    Article  Google Scholar 

  30. Rao AK, Daniels K, El-Sayed YY, Moshesh MK, Caughey AB . Perinatal outcomes among Asian American and Pacific Islander women. Am J Obstet Gynecol 2006; 195 (3): 834–838.

    Article  Google Scholar 

Download references

Acknowledgements

Financial Support: Henry C. Lee is the recipient of the Elizabeth and Russell Siegelman Pediatric Fellowship.

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Authors and Affiliations

  1. Department of Pediatrics, Stanford University, Stanford, CA, USA

    H C Lee & J B Gould

  2. Department of Obstetrics and Gynecology, Stanford University, Stanford, CA, USA

    Y Y El-Sayed

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  1. H C Lee
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Corresponding author

Correspondence to H C Lee.

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Lee, H., El-Sayed, Y. & Gould, J. Delivery mode by race for breech presentation in the US. J Perinatol 27, 147–153 (2007). https://doi.org/10.1038/sj.jp.7211668

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