Vaginal Breech Deliveries in the United States 1999–2013 [14H]

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Abstract

INTRODUCTION:

In 2000 Hannah concluded that a planned cesarean delivery is better for the term fetus in breech presentation, and an ACOG opinion stated that “… the decision regarding the mode of delivery should depend on the experience of the health care provider….” The objective of this study was to assess changes in vaginal delivery modes of breech presentation in the United States since 1999 (prior to the publication of the Hannah trial).

METHODS:

Retrospective cohort analysis comparing 1999, 2006, and 2013 CDC birth certificate data for term (over 37 weeks) singleton pregnancies without a prior cesarean delivery and birthweights over 2,499 grams. Vaginal delivery modes for breech presentation were calculated for all patients and by parity.

RESULTS:

In 2013 there were only 0.169% (3,324/1,969,545) vaginal breech among all term vaginal births. Vaginal breech deliveries decreased quickly and significantly by over 65% from 17.2% in 1999 to 6.9% in 2006 to 5.7% in 2013 (P<.0001). This was especially more pronounced for nullipara (11.9% vs 4.3% vs 3.5%; P<.0001) than multipara (25.0% vs 10.5% to 9.2%; P<.0001).

CONCLUSION:

Vaginal breech births are an exceedingly rare event in the United States occurring in 1 in 593 term vaginal births. After the Hannah publication in 2000 US vaginal breech deliveries decreased immediately and further over the subsequent 14 years. This likely prevents trainees and obstetricians to obtain sufficient experience in performing safe vaginal breech deliveries. Routine simulation of vaginal breech deliveries is necessary to train physicians in this rare event.

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