Breech Births Cause More Complications When Water Breaks Early

Breech births increase the risk of complications for both mother and baby when the amniotic sac ruptures early, claims a new study.

Researchers at Loyola University Health System (LUHS; Proviso, IL, USA) evaluated 569 women who had their water break for various reasons between 24 to 34 weeks' gestation. Of those, 458 did not have breech babies, while 111 did. Both groups had similar characteristics, including age, race, and medical and social history. The researchers found that the breech group was significantly more likely to have low amniotic fluid (68% versus 50%), and deliver at a significantly earlier gestational age (30.05 weeks versus 31.52 weeks).

The researchers found that breech pregnancies were significantly more likely to have an abruption where the placental lining separates from the uterus, causing serious complications (23% versus 12%). This group also was more likely to have the fetus die in utero (3% versus none). Neonatal outcomes were strikingly worse in the breech group, with increased occurrence of respiratory distress syndrome, necrotizing enterocolitis (NEC), a life-threatening intestinal issue, and neonatal death (9% versus 3%). The study was presented at the 79th annual meeting of the Central Association of Obstetricians and Gynecologists (CAOG), held during October 2012 in Chicago (IL, USA).

“Until now, there has been limited information available to guide management decisions in pregnancies affected by a premature rupture of the amniotic sac when the baby is breech,” said lead author Jean Goodman, MD, division director of Maternal-Fetal Medicine at LUHS. “We know now that fetal position affects outcomes for the mother and baby when a woman's water breaks prematurely. Additional research will be necessary to continue to guide our care for these women.”

A breech birth is delivery from a breech presentation, in which the baby enters the birth canal with the buttocks or feet first, as opposed to the normal head first presentation. Breech presentation incurs some hazards to the baby during the process of birth, including umbilical cord prolapse and compression damage; as a result, the majority of breech babies born in the United States are delivered by Caesarean section.

Rupture of the amniotic sac is considered premature when it occurs before the onset of labor prior to 37 weeks' gestation, and contributes to one-third of all preterm births. When the amniotic sac breaks prematurely, it can lead to serious adverse effects for the baby and the mother, including infections, heavy bleeding, oxygen deprivation to the fetus, and stillbirths.

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