Educational outcomes following breech delivery: a record-linkage study of 456947 children

Mackay, D. F. , Wood, R., King, A., Clark, D. N., Cooper, S.-A. , Smith, G. C.S. and Pell, J. P. (2015) Educational outcomes following breech delivery: a record-linkage study of 456947 children. International Journal of Epidemiology, 44(1), pp. 209-217. (doi:10.1093/ije/dyu270) (PMID:25613426)

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Abstract

Background: Obstetric management of term breech infants changed dramatically following the Term Breech Trial which suggested increased serious neonatal morbidity following trial of labour. Short-term morbidity is a poor proxy of long-term neurological sequelae. We determined whether vaginal breech delivery was associated with educational outcomes.<p></p> Methods: We linked three Scotland-wide administrative databases at an individual level: the ScotXed school census; Scottish Qualifications Authority (SQA) examination results; and Scottish Morbidity Record (SMR02) maternity database. The linkage provided information on singleton children, born at term, attending Scottish schools between 2006 and 2011.<p></p> Results: Of the 456 947 eligible children, 1574 (0.3%) had vaginal breech deliveries, 12 489 (2.7%) planned caesarean section for breech presentation and 442 090 (96.9%) vaginal cephalic deliveries. The percentage of term breech infants delivered vaginally fell from 23% to 7% among children who started school in 2006 and 2011, respectively. Of children born by vaginal breech delivery, 1.5% had a low 5-min Apgar score (≤3) compared with only 0.4% of those born by either breech caesarean section [adjusted odds ratio (OR) 6.16, 95% confidence interval (CI) 4.44–8.54, p < 0.001] or cephalic vaginal delivery (adjusted OR 3.84, 95% CI 2.99–4.93, p < 0.001). Children born by vaginal breech delivery had lower examination attainment than those born by either planned caesarean section for breech presentation (adjusted OR 1.16, 95% CI 1.02–1.32, p = 0.020) or vaginal cephalic delivery (adjusted OR 1.14, 95% CI 1.01–1.28, p = 0.029).<p></p> Conclusions: Vaginal delivery of term breech infants was associated with lower examination attainment, as well as poorer Apgar scores, suggesting that the adverse effects are not just short-term.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Cooper, Professor Sally-Ann and Pell, Professor Jill and Mackay, Dr Daniel
Authors: Mackay, D. F., Wood, R., King, A., Clark, D. N., Cooper, S.-A., Smith, G. C.S., and Pell, J. P.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Public Health
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Mental Health and Wellbeing
Journal Name:International Journal of Epidemiology
Publisher:Oxford University Press
ISSN:0300-5771
ISSN (Online):1464-3685

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