366: Long-term pediatric neurologic outcome following cesarean versus assisted vaginal delivery in breech deliveries

Breech presentation is the most common form of fetal malpresentation. Previous data suggested a better short-term outcome for neonates after Cesarean delivery (CD) compared to attempted vaginal delivery for breech presentation. The study was aimed to compare the long-term pediatric neurologic morbidity in offspring with breech presentation delivered by Cesarean versus assisted vaginal delivery. A retrospective population based cohort study was performed including all singleton deliveries in breech presentation occurring between 1991 and 2014 at a single tertiary medical center. A comparison was performed between children delivered via CD and those delivered vaginally. Multiple gestations, fetuses with congenital malformations, perinatal deaths and instrumental deliveries were excluded from the analysis. Pediatric hospitalizations of offspring up to the age of 18 years involving neurologic morbidity were evaluated. A Cox proportional hazards model was used to control for confounders. During the study period 7337 deliveries in breech presentation met the inclusion criteria; 86.9% were via CD (n=6,376) and 13.1% (n=961) were assisted vaginal deliveries. Hospitalizations up to the age of 18 years involving neurologic morbidity were higher, but did not reach significance, in offspring delivered by CD (Table). However, using a Cox proportional hazards model, while controlling for gestational age, birth-weight, neonatal gender, maternal age, parity, ethnicity, prenatal care and gestational diabetes mellitus, CD was noted as an independent and significant risk factor for long-term neurologic morbidity of the offspring (adjusted HR=1.5, CI 95% 1.2-2.2, p =0.035). Cesarean versus assisted vaginal delivery for breech presentation is an independent risk factor for long-term pediatric neurologic morbidity of the offspring.