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Breech presentation at delivery: a marker for congenital anomaly?

Journal of Perinatology volume 34, pages 11–15 (2014)Cite this article

Subjects

Abstract

Objective:

To determine whether congenital anomalies are associated with breech presentation at the time of birth.

Study Design:

A population-based, retrospective cohort study was conducted among 460 147 women with singleton live births using the Missouri Birth Defects Registry, which includes all defects diagnosed during the first year of life. Maternal and obstetric characteristics and outcomes between breech and cephalic presentation groups were compared using χ2-square statistic and Student’s t-test. Multivariable binary logistic regression analysis was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs).

Result:

At least one congenital anomaly was more likely present among infants breech at birth (11.7%) than in those with cephalic presentation (5.1%), whether full-term (9.4 vs 4.6%) or preterm (20.1 vs 11.6%). The relationship between breech presentation and congenital anomaly was stronger among full-term births (aOR 2.09, CI 1.96, 2.23, term vs 1.40, CI 1.26, 1.55, preterm), but not in all categories of anomalies.

Conclusion:

Breech presentation at delivery is a marker for the presence of congenital anomaly. Infants delivered breech deserve special scrutiny for the presence of malformation.

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References

  1. Cruikshank DP . Breech presentation. Clin Obstet Gynecol 1986; 29: 255–263.

    Article  CAS  Google Scholar 

  2. Braun FHT, Jones KL, Smith DW . Breech presentation as an indicator of fetal abnormality. J Pediatr 1975; 86: 419–421.

    Article  CAS  Google Scholar 

  3. Axelrod FB, Leistner HL, Porges RF . Breech presentation among infants with familial dysautonomia. J Pediatr 1974; 84: 107–109.

    Article  CAS  Google Scholar 

  4. Fianu S, Vaclavinkova V . The site of placental attachment as a factor in the aetiology of breech presentation. Acta Obstet Gynecol Scand 1978; 57: 371–372.

    Article  CAS  Google Scholar 

  5. Brenner WE, Bruce RD, Hendricks CH . The characteristics and perils of breech presentation. Am J Obstet Gynecol 1974; 118: 700–712.

    Article  CAS  Google Scholar 

  6. Luterkort M, Persson P, Weldner B . Maternal and fetal factors in breech presentation. Obstet Gynecol 1984; 64: 55–59.

    Article  CAS  Google Scholar 

  7. Rayl J, Gibson PJ, Hickok DE . A population-based case-control study of risk factors for breech presentation. Am J Obstet Gynecol 1996; 174: 28–32.

    Article  CAS  Google Scholar 

  8. Axelrod FB, Porges RF, Sein ME . Neonatal recognition of familial dysautonomia. J Pediatr 1987; 110: 946–948.

    Article  CAS  Google Scholar 

  9. Gimovsky ML, Paul RH . Singleton breech presentation in labor: experience in 1980. Am J Obstet Gynecol 1982; 143: 733–739.

    Article  CAS  Google Scholar 

  10. Berendes HW, Weiss W, Deutschberger J, Jackson E . Factors associated with breech delivery. Am J Public Health Health 1965; 55: 708–719.

    Article  CAS  Google Scholar 

  11. Mazor M, Hagay ZJ, Leiberman JR, Biale Y, Insler V . Fetal malformations associated with breech delivery. Implications for obstetric management. J Reprod Med 1985; 30: 884–886.

    CAS  PubMed  Google Scholar 

  12. Alexander GR, Kogan MD, Himes JH . 1994–1996 US singleton birth weight percentiles for gestational age by race, Hispanic origin, and gender. Matern Child Health J 1999; 3: 225–231.

    Article  CAS  Google Scholar 

  13. Sorensen T, Hasch E, Lange AP . Fetal presentation during pregnancy [Letter]. Lancet 1979; 2: 477.

    Article  CAS  Google Scholar 

  14. Mickey RM, Greenland S . The impact of confounder selection criteria on effect estimation. Am J Epidemiol 1989; 129: 125–137.

    Article  CAS  Google Scholar 

  15. Hall JE, Kohl SG, O’Brien F, Ginsberg M . Breech presentation and perinatal mortality. Am J Obstet Gynecol 1965; 91: 665–683.

    CAS  PubMed  Google Scholar 

  16. Kauppila O . The perinatal mortality in breech deliveries and observations on affecting factors: a retrospective study of 2227 cases. Acta Obstet Gynecol Scand (Suppl) 1975; 39: 1–79.

    CAS  Google Scholar 

  17. Goldberg JD . Routine screening for fetal anomalies: expectations. Obstet Gynecol Clin N Am 2004; 31: 35–50.

    Article  Google Scholar 

  18. Grandjean H, Larroque D, Levi S . Sensitivity of routine ultrasound screening of pregnancies in the Eurofetus database. The Eurofetus Team. Ann N Y Acad Sci 1998; 847: 118–124.

    Article  CAS  Google Scholar 

  19. Wren C, Reinhardt Z, Khawaja K . Twenty-year trends in diagnosis of life-threatening neonatal cardiovascular malformations. Arch Dis Child Fetal Neonatal Ed 2008; 93: F33–F35.

    Article  CAS  Google Scholar 

  20. Bower C, Rudy E, Callaghan A, Quick J, Nassar N . Age at diagnosis of birth defects. Birth Defects Res A Clin Mol Teratol 2010; 88: 251–255.

    CAS  PubMed  Google Scholar 

  21. Tanner JP, Salemi JL, Hauser KW, Correia JA, Watkins SM, Kirby RS . Birth defects surveillance in Florida: infant death certificates as a case ascertainment source. Birth Defects Res A Clin Mol Teratol 2010; 88: 1017–1022.

    Article  CAS  Google Scholar 

  22. Wang Y, Sharpe-Stimac M, Cross PK, Druschel CM, Hwang S . Improving case ascertainment of a population-based birth defects registry in New York state using hospital discharge data. Birth Defects Res A Clin Mol Teratol 2005; 73: 663–668.

    Article  CAS  Google Scholar 

  23. Salemi JL, Tanner JP, Kennedy S, Block S, Bailey M, Correia JA et al. A comparison of two surveillance strategies for selected birth defects in Florida. Public Health Rep 2012; 127: 391–400.

    Article  Google Scholar 

  24. Frost F, Starzyk P, George S, McLaughlin JF . Birth complication reporting: the effect of birth certificate design. Am J Public Health 1984; 74: 505–506.

    Article  CAS  Google Scholar 

  25. Zollinger TW, Przybylski MJ, Gamache RE . Reliability of Indiana birth certificate data compared to medical records. Ann Epidemiol 2006; 16: 1–10.

    Article  Google Scholar 

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Acknowledgements

Many thanks go to Gilad Gross, MD for his helpful advice on improving this manuscript. The authors also acknowledge the Missouri Department of Health and Senior Services, Section of Epidemiology for Public Health Practice as the original source of the data. The analysis, interpretations and conclusions in the present study are those of the authors and not the Missouri Department of Health and Senior Services, Section of Epidemiology for Public Health Practice.

Author information

Author notes

  1. T L Leet: Dr Leet is deceased.

Authors and Affiliations

  1. Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Women’s Health, School of Medicine, Saint Louis University, St Louis, MO, USA

    D Mostello

  2. Department of Epidemiology, School of Public Health, Saint Louis University, St Louis, MO, USA

    J J Chang, F Bai, K Stamps & T L Leet

  3. Department of Biostatistics, School of Public Health, Saint Louis University, St Louis, MO, USA

    J Wang

  4. Department of Pediatrics and the Center for Outcomes Research, School of Medicine, Saint Louis University, St Louis, MO, USA

    C Guild

Authors
  1. D Mostello
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  2. J J Chang
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  3. F Bai
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  4. J Wang
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  5. C Guild
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  6. K Stamps
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  7. T L Leet
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Corresponding author

Correspondence to D Mostello.

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The authors declare no conflict of interest.

Additional information

Presented at the 32nd Annual Meeting of the Society for Maternal-Fetal Medicine, February 6–11, 2012, Dallas, TX, USA.

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Mostello, D., Chang, J., Bai, F. et al. Breech presentation at delivery: a marker for congenital anomaly?. J Perinatol 34, 11–15 (2014). https://doi.org/10.1038/jp.2013.132

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