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Evidence-based changes in term breech delivery practice in Sweden.

https://arctichealth.org/en/permalink/ahliterature29713
Source
Acta Obstet Gynecol Scand. 2005 Jun;84(6):584-7
Publication Type
Article
Date
Jun-2005
Author
Olof Alexandersson
Marie Bixo
Ulf Högberg
Author Affiliation
Obstetrics and Gynecology, Department of Clinical Science, Umea University, Sweden.
Source
Acta Obstet Gynecol Scand. 2005 Jun;84(6):584-7
Date
Jun-2005
Language
English
Publication Type
Article
Keywords
Adult
Breech Presentation
Delivery, Obstetric - methods - utilization
Evidence-Based Medicine
Female
Health Facility Size
Humans
Infant, Newborn
Obstetrics - trends
Outcome and Process Assessment (Health Care)
Physician's Practice Patterns - trends
Practice Guidelines
Pregnancy
Pregnancy outcome
Registries
Sweden - epidemiology
Abstract
OBJECTIVE: Medical documentation on term breech delivery (TBD) advocates planned abdominal delivery based on evidence. The aim of the present study was to describe a change in TBD practice in Sweden following evidence-based documentation arguing in favor of TBD by cesarean section (CS). MATERIALS AND METHODS: The study was a population-based observational study based on data from the Swedish Medical Birth Register. Eligible subjects were all mothers with singleton children in term breech (TB) presentation born between 1999 and 2001 at > 36 weeks' gestational age. Data were processed, and subjects were subdivided into groups, according to mode of delivery. RESULTS: The CS rate increased from 75.3% in 1999 to 86.0% in 2001, due to an increase in planned abdominal deliveries. The change towards abdominal deliveries was more obvious for hospitals with fewer deliveries. While today, an increasing number of hospitals clearly have a non-selective CS policy, with a > 95% CS rate, others still deliver 30% of TB babies vaginally. CONCLUSION: In conclusion, the evidence-based recommendation for TBD has so far had considerable impact on Swedish obstetric practice.
PubMed ID
15901271 View in PubMed
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Good perinatal outcome in selective vaginal breech delivery at term.

https://arctichealth.org/en/permalink/ahliterature174747
Source
Acta Obstet Gynecol Scand. 2005 Jun;84(6):578-83
Publication Type
Article
Date
Jun-2005
Author
Jukka Uotila
Risto Tuimala
Pertti Kirkinen
Author Affiliation
Department of Obstetrics and Gynecology, Tampere University Hospital, Finland. jukka.uotila@uta.fi
Source
Acta Obstet Gynecol Scand. 2005 Jun;84(6):578-83
Date
Jun-2005
Language
English
Publication Type
Article
Keywords
Adult
Breech Presentation
Cesarean Section - methods - utilization
Cohort Studies
Delivery, Obstetric - methods - utilization
Female
Finland - epidemiology
Humans
Infant, Newborn
Pregnancy
Pregnancy outcome
Pregnancy Trimester, Third
Abstract
To compare perinatal outcome in groups of planned vaginal breech delivery, elective cesarean section with the fetus in breech presentation, and planned vaginal delivery with the fetus in cephalic presentation in a university hospital with a tradition of managing breech deliveries by the vaginal route.
A cohort study from a 7-year period 1995-2002, including 590 planned vaginal deliveries with a term (> 37 weeks) singleton fetus in breech presentation, 396 elective cesarean sections with a term singleton fetus in breech presentation, and 590 control women intending vaginal delivery with a singleton term fetus in cephalic presentation.
The Apgar scores were lower in the group of planned vaginal breech delivery, but in other outcome measures there were no significant intergroup differences. The overall neonatal morbidity was small (1.2% vs. 0.5% vs. 0.3% in the respective study groups) if compared to a recently published randomized multicenter study.
Selective vaginal breech deliveries may be safely undertaken in units having a tradition of vaginal breech deliveries.
PubMed ID
15901270 View in PubMed
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Mode of obstetrical delivery and type 1 diabetes: a sibling design study.

https://arctichealth.org/en/permalink/ahliterature257758
Source
Pediatrics. 2014 Sep;134(3):e806-13
Publication Type
Article
Date
Sep-2014
Author
Ali S Khashan
Louise C Kenny
Cecilia Lundholm
Patricia M Kearney
Tong Gong
Catarina Almqvist
Author Affiliation
The Irish Centre for Fetal and Neonatal Translational Research (INFANT) and Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, University College Cork, Ireland; a.khashan@ucc.ie.
Source
Pediatrics. 2014 Sep;134(3):e806-13
Date
Sep-2014
Language
English
Publication Type
Article
Keywords
Adult
Cesarean Section - methods - utilization
Cohort Studies
Delivery, Obstetric - methods - utilization
Diabetes Mellitus, Type 1 - complications - diagnosis - epidemiology
Female
Humans
Obstetrical Forceps - utilization
Population Surveillance - methods
Pregnancy
Pregnancy in Diabetics - diagnosis - epidemiology
Siblings
Sweden - epidemiology
Young Adult
Abstract
We investigated the association between cesarean section (CS) and type 1 diabetes (T1D), and if the association remains after accounting for familial confounding by using a sibling-control design.
We conducted a population-based cohort study of all singleton live births in Sweden between 1982 and 2009, followed by sibling-control analyses. T1D diagnoses were identified from the Swedish National Patient Register. Mode of delivery was categorized into unassisted vaginal delivery (reference group), instrumental vaginal delivery (IVD), emergency CS, and elective CS. The statistical analysis was conducted in 2 steps: firstly log-linear Poisson regression with aggregated person-years by using the full cohort; secondly, conditional logistic regression for sibling-control analyses. The sibling analysis included siblings who were discordant for both mode of delivery and T1D.
In the cohort analyses (N = 2?638?083), there was an increased risk of childhood T1D among children born by elective CS (adjusted relative risk [RR] = 1.15 [95% confidence interval: 1.06-1.25]) and IVD (RR=1.14 [1.06-1.23]) but not emergency CS (RR = 1.02 [0.95-1.11]) when compared with children born by unassisted vaginal birth. However, the effect of elective CS and IVD on childhood T1D almost disappeared and became nonsignificant in the sibling-control analyses.
The present findings suggest a small association between elective CS and IVD and T1D. The sibling-control results, however, suggest that these findings are not consistent with causal effects of mode of delivery on T1D and may be due to familial confounders such as genetic susceptibility and environmental factors.
PubMed ID
25092933 View in PubMed
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