Mode of delivery and outcome of 699 term singleton breech deliveries at a single center.

OBJECTIVE: Elective cesarean delivery has been postulated to improve the outcome of term fetuses in breech presentation. We retrospectively compared the short- and long-term outcomes of term infants who were delivered from a breech presentation at a single center. STUDY DESIGN: We reviewed 699 consecutive term breech presentations according to the intended mode of delivery at a single center between January 1993 and December 1999. The short-term outcome measures were perinatal death, neonatal death, or serious neonatal morbidity; the long-term outcome measures were developmental delay and spasticity. RESULTS: The rate of serious perinatal morbidity in the trial-of-labor and cesarean delivery groups was 2.3% and 0.5%, respectively (P =.12). There was no perinatal or neonatal death in either group. With a median follow-up period of 57 months (range, 13-100 months), the rate of developmental delay was 1.9% and 0.5%, respectively (P =.29). Spasticity was not noted in any of the children. CONCLUSION: Our data suggest that planned vaginal delivery remains an option for selected term breech presentations.

The impact of body mass index and weight gain during pregnancy on puerperal complications after spontaneous vaginal delivery.

BACKGROUND: We studied the effect of the prepregnancy body mass index (BMI) and weight gain during pregnancy on the rate of puerperal complications after spontaneous vaginal delivery. METHODS: This is a prospective cohort study of 11,114 women delivered spontaneously between 36 and 43 week's gestation at a university hospital, between January 1996 and December 2000. Postpartum complications were analyzed according to prepregnancy BMI category (low < 19.8; normal 19.8-26; high 26.1-29; obese > 29) and weight gain during pregnancy. Weight gain was defined as low, normal or high according to the National Academy of Science recommendations for BMI. RESULTS: Overall, 7.3% women had complications. Anemia and readmission were significantly more common in lean women than in women with normal BMI (3.5% versus 2.6%; P = .021 and 1.0% versus 0.3%; P < .001, respectively). Obese women had significantly more infectious complications (especially urinary tract infection) than women with normal BMI (6.3% versus 3.8%; P = .005). CONCLUSIONS: These results suggest that obese women should be screened for puerperal urinary tract infection. Weight gain during pregnancy has no influence on puerperal complications.