Neonatal Outcomes Associated with Noncephalic Presentation at Delivery in Preterm Birth

Abstract

Objective The objective of this study is to evaluate the effect of noncephalic presentation on neonatal outcomes in preterm delivery.

Study Design In this study a secondary analysis of the BEAM trial was performed. It included women with singleton, liveborn, and nonanomalous fetuses. Neonatal outcomes were compared in noncephalic versus cephalic presentation. Adjusted odds ratios and 95% confidence intervals were calculated for each outcome with logistic regression while controlling for possible confounders. A stratified analysis by mode of delivery was also performed in this study.

Results A total of 458 noncephalic deliveries were compared with 1,485 cephalic deliveries. In multivariate analysis, noncephalic presentation was associated with increased risk of death in the neonatal intensive care unit (NICU) or death at <15 months corrected gestational age (cGA), and a decreased risk of IVH. The risk of death persisted in stratified analysis, with increased risk of death at <15 months cGA in noncephalic neonates born via cesarean delivery. In the vaginal delivery group, there was an increased risk of death at <15 months cGA and NICU death.

Conclusion After controlling for possible confounders, neonates who are noncephalic at delivery have higher risk for death <15 months cGA and death in the NICU while their risk of IVH is reduced. The risk of death persisted in stratified analyses by mode of delivery.

Keywords

cesarean delivery - preterm delivery - neonatal mortality - malpresentation

Condensation

Noncephalic presentation in preterm delivery is associated with adverse neonatal outcomes.

Note

This paper was presented at the Society of Maternal Fetal Medicine 2017 in Las Vegas, Nevada, from January 23 to 28, 2017.

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