Influence of maternal-fetal medicine subspecialization on the frequency of trial of labor in term pregnancies with breech presentation

Abstract

Objective: To investigate the role of subspecialization in maternal-fetal medicine (MFM) on the frequency of a trial of labor in term pregnancies with breech presentation.

Methods: We conducted a retrospective study of 332 singleton pregnancies ≥37 weeks with nonfootling breech presentation that delivered over a 6-year period (1994–1998) at a university-based, tertiary care hospital. Patients were divided into two groups based on whether the delivery was attended by an MFM or non-MFM obstetrician-gynecologist. Demographic and clinical data were compared between groups and outcome variables included whether the patient had an attempt at vaginal delivery, cesarean delivery after a labor attempt, or vaginal breech delivery.

Results: The frequency of labor attempt (OR 1.4, 95% CI 0.9–2.3), vaginal breech success rate (OR 0.6, 95% CI 0.3–1.5), and overall cesarean rates (OR 0.9, 95% CI 0.5–1.7) were similar between groups. Using discriminant function analysis, only nulliparity (R² = 1.6%, F = 6.0, P = 0.005) and birthweight (R² = 2.0% F = 6.4, P = 0.01) were associated with trial of vaginal delivery.

Conclusions: Subspecialization in MFM had no impact on the frequency of trial of labor in the term pregnancy with a breech presentation.

Key Words:

• breech delivery
• maternal fetal medicine
• cesarean delivery