Optimal time intervals for vaginal breech births: a case-control study [version 2; peer review: 1 approved, 2 approved with reservations, 1 not approved]
Background: Breech births are associated with a high rate of hypoxic injury, in part due to cord occlusion during emergence. Maximum time intervals and guidelines oriented toward earlier intervention have been proposed in a Physiological Breech Birth Algorithm. We wished to further test and refine t...
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| Format: | Article |
| Language: | English |
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F1000 Research Ltd
2022-09-01
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| Series: | NIHR Open Research |
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| Online Access: | https://openresearch.nihr.ac.uk/articles/2-45/v2 |
| _version_ | 1797847483613708288 |
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| author | Shawn Walker Emma Spillane Christine McCourt |
| author_facet | Shawn Walker Emma Spillane Christine McCourt |
| author_sort | Shawn Walker |
| collection | DOAJ |
| description | Background: Breech births are associated with a high rate of hypoxic injury, in part due to cord occlusion during emergence. Maximum time intervals and guidelines oriented toward earlier intervention have been proposed in a Physiological Breech Birth Algorithm. We wished to further test and refine the Algorithm for use in a clinical trial. Methods: We conducted a retrospective case-control study in a London teaching hospital, including 15 cases and 30 controls, during the period of April 2012 to April 2020. Our sample size was powered to test the hypothesis that exceeding recommended time limits is associated with neonatal admission or death. Data collected from intrapartum care records was analysed using SPSS v26 statistical software. Variables were intervals between the stages of labour and various stages of emergence (presenting part, buttocks, pelvis, arms, head). The chi-square test and odds ratios were used to determine association between exposure to the variables of interest and composite outcome. Multiple logistic regression was used to test the predictive value of delays defined as non-adherence the Algorithm. Results: Logistic regression modelling using the Algorithm time frames had an 86.8% accuracy, a sensitivity of 66.7% and a specificity of 92.3% for predicting the primary outcome. Delays between umbilicus and head >3 minutes (OR: 9.508 [95% CI: 1.390-65.046] p=0.022) and from buttocks on the perineum to head >7 minutes (OR: 6.682 [95% CI: 0.940-41.990] p=0.058) showed the most effect. Lengths of time until the first intervention were consistently longer among the cases. Delay in intervention was more common among cases than head or arm entrapment. Conclusion: Emergence taking longer than the limits recommended in the Physiological Breech Birth algorithm may be predictive of adverse outcomes. Some of this delay is potentially avoidable. Improved recognition of the boundaries of normality in vaginal breech births may help improve outcomes. |
| first_indexed | 2024-04-09T18:13:13Z |
| format | Article |
| id | doaj.art-3097cbe6f20a4f579c8184d62d19e6ef |
| institution | Directory Open Access Journal |
| issn | 2633-4402 |
| language | English |
| last_indexed | 2024-04-09T18:13:13Z |
| publishDate | 2022-09-01 |
| publisher | F1000 Research Ltd |
| record_format | Article |
| series | NIHR Open Research |
| spelling | doaj.art-3097cbe6f20a4f579c8184d62d19e6ef2023-04-13T11:02:15ZengF1000 Research LtdNIHR Open Research2633-44022022-09-01214441Optimal time intervals for vaginal breech births: a case-control study [version 2; peer review: 1 approved, 2 approved with reservations, 1 not approved]Shawn Walker0https://orcid.org/0000-0003-3658-8988Emma Spillane1https://orcid.org/0000-0002-6663-7093Christine McCourt2https://orcid.org/0000-0003-4765-5795Women and Children's Health, King's College London, 10th floor North Wing, St Thomas' Hospital, London, SE1 7EH, UKMaternity Services, Kingston NHS Foundation Trust, Kingston upon Thames, London, KT2 7QB, UKCentre for Maternal & Child Health Research, City, University of London, 1 Myddleton Street, London, EC1R 1UB, UKBackground: Breech births are associated with a high rate of hypoxic injury, in part due to cord occlusion during emergence. Maximum time intervals and guidelines oriented toward earlier intervention have been proposed in a Physiological Breech Birth Algorithm. We wished to further test and refine the Algorithm for use in a clinical trial. Methods: We conducted a retrospective case-control study in a London teaching hospital, including 15 cases and 30 controls, during the period of April 2012 to April 2020. Our sample size was powered to test the hypothesis that exceeding recommended time limits is associated with neonatal admission or death. Data collected from intrapartum care records was analysed using SPSS v26 statistical software. Variables were intervals between the stages of labour and various stages of emergence (presenting part, buttocks, pelvis, arms, head). The chi-square test and odds ratios were used to determine association between exposure to the variables of interest and composite outcome. Multiple logistic regression was used to test the predictive value of delays defined as non-adherence the Algorithm. Results: Logistic regression modelling using the Algorithm time frames had an 86.8% accuracy, a sensitivity of 66.7% and a specificity of 92.3% for predicting the primary outcome. Delays between umbilicus and head >3 minutes (OR: 9.508 [95% CI: 1.390-65.046] p=0.022) and from buttocks on the perineum to head >7 minutes (OR: 6.682 [95% CI: 0.940-41.990] p=0.058) showed the most effect. Lengths of time until the first intervention were consistently longer among the cases. Delay in intervention was more common among cases than head or arm entrapment. Conclusion: Emergence taking longer than the limits recommended in the Physiological Breech Birth algorithm may be predictive of adverse outcomes. Some of this delay is potentially avoidable. Improved recognition of the boundaries of normality in vaginal breech births may help improve outcomes.https://openresearch.nihr.ac.uk/articles/2-45/v2Breech Presentation Midwifery Obstetrics Medical Education Case-Control Delivery: Breecheng |
| spellingShingle | Shawn Walker Emma Spillane Christine McCourt Optimal time intervals for vaginal breech births: a case-control study [version 2; peer review: 1 approved, 2 approved with reservations, 1 not approved] NIHR Open Research Breech Presentation Midwifery Obstetrics Medical Education Case-Control Delivery: Breech eng |
| title | Optimal time intervals for vaginal breech births: a case-control study [version 2; peer review: 1 approved, 2 approved with reservations, 1 not approved] |
| title_full | Optimal time intervals for vaginal breech births: a case-control study [version 2; peer review: 1 approved, 2 approved with reservations, 1 not approved] |
| title_fullStr | Optimal time intervals for vaginal breech births: a case-control study [version 2; peer review: 1 approved, 2 approved with reservations, 1 not approved] |
| title_full_unstemmed | Optimal time intervals for vaginal breech births: a case-control study [version 2; peer review: 1 approved, 2 approved with reservations, 1 not approved] |
| title_short | Optimal time intervals for vaginal breech births: a case-control study [version 2; peer review: 1 approved, 2 approved with reservations, 1 not approved] |
| title_sort | optimal time intervals for vaginal breech births a case control study version 2 peer review 1 approved 2 approved with reservations 1 not approved |
| topic | Breech Presentation Midwifery Obstetrics Medical Education Case-Control Delivery: Breech eng |
| url | https://openresearch.nihr.ac.uk/articles/2-45/v2 |
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