Preterm breech in Finland -risks and outcomes

Anna Toijonen

Tutkimustuotos: OpinnäyteVäitöskirjaArtikkelikokoelma

Abstrakti

Approximately 5% of neonates are born preterm in Finland, and 20% of these are in breech presentation at the time of birth. Thesis included register linkage studies that examined the predictors for preterm breech presentation and the safety of preterm breech labor in 2004–2018 in Finland. The study demonstrated that the number of predisposing factors for breech presentation increase with increasing gestational age. Some of the predisposing factors for breech presentation are already noticeable at 28–32 weeks, such as maternal preeclampsia / high blood pressure, preterm premature rupture of membranes, and fetal growth restriction. The predisposing factors for breech presentation in late preterm were advanced maternal age, primiparity, a history of a cesarean section, preterm premature rupture of membranes, oligohydramnios, fetal growth restriction, female sex, and congenital anomaly. The risk factors for neonatal morbidity and mortality in vaginal preterm breech labor were assessed. Neonatal morbidity in a trial of vaginal preterm breech labor associated with maternal obesity, smoking, congenital anomalies, preterm premature rupture of membranes, oligohydramnios, and fetal growth restriction. Third study evaluated whether vaginal breech labor at 32 – 37 weeks is associated with an increased risk of short-term neonatal morbidity or mortality compared to cesarean section. Severe neonatal adverse outcomes (neonatal death, an arterial umbilical pH < 7.00, 5 min Apgar < 4) were not increased after vaginal breech labor. Still, the risk of having a 5 min Apgar < 7 was higher among fetuses with vaginal breech labor than fetuses born by cesarean section. The need for neonatal antibiotic therapy, neonatal intensive care unit, and neonatal respiratory distress syndrome were decreased after vaginal breech labor compared to non-urgent cesarean sections. Lastly, the impact of fetal presentation on neurodevelopmental outcomes in a trial of preterm vaginal labor was examined. The incidences of cerebral palsy, epilepsy, intellectual disability, autism spectrum disorder, attention-deficit/hyperactivity disorder, and speech, visual, and auditory disabilities were evaluated at the age of four years according to the fetal presentation at the time of delivery. No association between a trial of vaginal breech delivery at 24– 32 weeks and neurodevelopmental delay was found. Yet, the risks of visual defects and autism spectrum disorders were higher after late preterm breech labor than among controls who were born in a cephalic presentation. The findings demonstrate that previous results on term breech deliveries could not be fully applied to preterm breech deliveries.
Alkuperäiskielienglanti
Valvoja/neuvonantaja
  • Heinonen, Seppo Tapani, Valvoja
  • Macharey, Georg W, Valvoja
JulkaisupaikkaHelsinki
Kustantaja
Painoksen ISBN978-951-51-8029-2
Sähköinen ISBN978-951-51-8030-8
TilaJulkaistu - 2022
OKM-julkaisutyyppiG5 Tohtorinväitöskirja (artikkeli)

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M1 - 129 s. + liitteet

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