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Less incontinence with C-section in Breech births: Vaginal births show 2.8% higher rate. (Analysis of Term Breech Trial).

NEW ORLEANS -- Decreasing the risk for urinary incontinence is another reason why planned cesarean section should be favored over planned vaginal birth with breech presentation, Dr. Mary E. Hannah said at the annual meeting of the Society for Maternal-Fetal Medicine.

Among 1,596 women who participated in the Term Breech Trial and responded to a questionnaire 3 months post partum, stress incontinence was reported by 4.5% of those who had planned cesarean section delivery, compared with 7.3% of those with planned vaginal birth.

"Planned cesarean delivery also is not associated with increased risk of other postpartum problems," Dr. Hannah said in a poster session at the meeting, which was cosponsored by the American College of Obstetricians and Gynecologists.

The questionnaire also sought information about the need for the mother or baby to return for medical care, breast-feeding, ease of caring for the baby, and adjustment to new motherhood. In addition, the women were asked about their sexual relations and relationship with their husband or partner, depression, and their childbirth experience.

The increased rate of urinary stress incontinence was the only finding that differed significantly between the two groups. "Incontinence of flatus was not different between groups, but was less of a problem in the planned cesarean section group, if it occurred," Dr. Hannah said.

A total of 90.9% of women in the planned cesarean group were delivered by this route, while only 57.1% of those in the planned vaginal delivery group ultimately were delivered vaginally.

This study derived from the larger Term Breech Trial, which included 2,088 women from 121 centers in 26 countries. The original study found that with breech presentation, there were significant decreases in perinatal mortality, neonatal mortality and serious neonatal morbidity among women randomly assigned to planned cesarean delivery, compared with those assigned to planned vaginal delivery (Lancet 356[9239]:1375-83, 2000). The investigators reported that the perinatal mortality rate was 12.5 / 1,000 in the vaginal birth group, compared with 2.9/1,000 in the cesarean group. Serious maternal complications were similar between the two groups.

Dr. Hannah of the University of Toronto was an investigator and lead author of that study, which sought to reduce the uncertainty associated with breech deliveries. Controversy continues, however, as was seen when publication of the breech trial generated a flurry of correspondence questioning issues such as assessment of pelvic adequacy, estimation of fetal body weight, differences in medical practice, and applicability of conclusions between developed and developing countries where wide disparities exist in perinatal mortality rate (Lancet. 357[9251]:225-28, 2001).
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Author:Walsh, Nancy
Publication:OB GYN News
Date:Mar 15, 2002
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