Outcomes at 3 Months After Planned Cesarean vs Planned Vaginal Delivery for Breech Presentation at Term: The International Randomized Term Breech Trial
| Autor: | Amiram Gafni, Mary Cheng, Sheila Hewson, Saroj Saigal, Hilary Whyte, Ellen Hodnett, Beverley Chalmers, Rose Kung, Walter J. Hannah, Kofi Amankwah, Michael Helewa, Andrew R. Willan, Mary E. Hannah |
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| Rok vydání: | 2002 |
| Předmět: |
Postpartum depression
medicine.medical_specialty Sexual Behavior Pain Urinary incontinence law.invention Randomized controlled trial Pregnancy Breech presentation law medicine Elective Cesarean Delivery Humans Childbirth Sex organ Breech Presentation Maternal Behavior reproductive and urinary physiology Cesarean Section Depression Obstetrics Vaginal delivery business.industry Postpartum Period Pregnancy Outcome Obstetrics and Gynecology Puerperal Disorders General Medicine Delivery Obstetric medicine.disease Mother-Child Relations Breast Feeding Treatment Outcome Urinary Incontinence Elective Surgical Procedures Patient Satisfaction Female medicine.symptom business Follow-Up Studies |
| Zdroj: | Scopus-Elsevier |
| ISSN: | 0029-7828 |
| DOI: | 10.1097/00006254-200209000-00006 |
| Popis: | The Term Breech Trial, a randomized study of 2088 women, demonstrated a significant reduction in adverse perinatal outcomes when breech presentation was managed by planned cesarean delivery rather than planned vaginal delivery. Respective rates of adverse outcomes were 1.6% and 5%. At the same time, there was no greater risk of immediate maternal morbidity in the cesarean group. Other studies suggest that cesarean delivery may lead to problems with breast-feeding, postpartum depression, and negative feelings about childbirth. The present study is a 3-month postpartum follow-up of 1596 study participants, at 110 centers worldwide, who had a singleton fetus in breech presentation at term. Baseline data were similar for the 798 women randomly assigned to planned cesarean delivery and for the same number randomly assigned to planned vaginal birth. Cesarean delivery was carried out as planned in 91% of cases, but only 57% of women assigned to vaginal delivery were managed in this way. The commonest reasons for operative delivery were fetopelvic disproportion, failure to progress in labor, and fetal heart rate abnormality. Most women in both groups found it easy to care for their new infant and to be a new mother. Fewer women assigned to cesarean delivery breast-fed their infants starting shortly after birth. The planned delivery method did not influence sexual relations or women's relationships with their husband or partner. Pain in general was comparable in the two groups at 3-month follow-up, but women assigned to cesarean delivery more often had pain on the outside of the abdomen or deep inside the abdomen. Fewer women in this group had pain in the bottom or genital area. In addition, more women assigned to vaginal delivery reported having leaked or lost urine in the past week (7.3% vs. 4.5%). Very few women in either group reported losing or leaking feces, fluid, or mucus from their bowels. Postpartum depression was identified in 10% to 11% of both groups. Women assigned to cesarean delivery appreciated the fact that childbirth was not very painful and felt reassured about their infant's health. Women assigned to planned vaginal delivery liked the naturalness of the procedure and the opportunity to participate actively in their child's birth. They also felt that recovery was not difficult. The groups did not differ significantly in their view of the delivery method to which they were assigned. The investigators believe it reasonable to offer elective cesarean delivery to women with a breech presentation if there is a substantial risk that emergency cesarean will be necessary should vaginal delivery be planned. This policy has not been associated with higher rates of postpartum problems, and it may lessen the risk of urinary incontinence. |
| Databáze: | OpenAIRE |
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