Defense Date

2007

Document Type

Thesis

Degree Name

Master of Public Health

Department

Epidemiology & Community Health

First Advisor

Dr. Elizabeth Eustis Turf

Abstract

Introduction: Approximately 3% to 4% of all pregnancies at term will have a fetus with a breech presentation. Studies have shown that the US has almost completely abandoned vaginal delivery for breech presentation through the influence of the "Term Breech Trial" (TBT) which concluded that a policy of planned caesarian section would reduce perinatal mortality, late neonatal mortality, and serious neonatal morbidity by approximately two-thirds for term fetuses. However, the recommendations are still being challenged by others.Objectives: The purpose of the study was to describe who in Virginia is having a vaginal delivery for a breech presentation and to determine if there is a difference in birth outcome based on mode of delivery for breech presentation of term infants.Methods: This population-based study used all birth records for term infants with breech presentation delivered between 1996 and 2005. Data were obtained from the Center for Health Statistics at the Virginia Department of Health. Descriptive statistics were done to characterize vaginal and caesarean section deliveries. These methods were compared using logistic regression for infant mortality and 5-minute Apgar scores as dependent variables.Results: In Virginia, over the last ten years, the prevalence of vaginal deliveries dropped from 13.1% to 6.6% for full term infants with a breech presentation, a decrease of almost 50%. Black women, younger mothers between the ages of 12 and 24, and women with less than or equal to a high school education had the highest occurrence of vaginal births. In the logistic models, the risk for infant death was highest for black women [OR = 1.93; (1.56, 2.38)], women with more than 13 prenatal visits [OR = 1.25; (1.02, 1.53) for 13-15 visits, OR = 2.33; (1 .82, 2.98) for >15 visits], infants who had a low birth weight [OR = 2.8 1 ; (2.08, 3.79)], and women who had a vaginal delivery [OR = 1.42; (1.10, 1.84)] The characteristics that were associated with a lower 5-minute Apgar score for breech infants delivered vaginally included the mother's method of payment, [Medicaid OR 1.75; (1.03, 2.97) and self pay OR 2.33; (1.13, 4.83)], low birth weight [OR = 2.54; (1.24, 5.22)], and delivery type [OR = 4.71; (2.95, 7.52)].Discussion/Conclusions: Our data showed that women who have a vaginal delivery for a term breech infant were more likely to be black, 12-24 years of age, no private insurance, and fewer prenatal visits and was associated with higher infant mortality and lower 5-minute Apgar scores. However, our results indicated that these infants had other significant problems, as indicated by the association with a high number of prenatal visits. Therefore, having physicians who are experienced in delivering breech infants vaginally, careful exclusion of risk factors and, educating the patient about the risks and complications of a vaginal delivery for breech fetuses could help decrease the potential risks for the mother and the infant.

Rights

© The Author

Is Part Of

VCU University Archives

Is Part Of

VCU Theses and Dissertations

Date of Submission

June 2008

Included in

Epidemiology Commons

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