Cesarean Rate and Risk Factors for Singleton Breech Presentation in China

Abstract

Objective: To determine the risk factors for breech birth, as well as the rates of cesarean section in singleton breech births in different Chinese provinces.

Study design: This retrospective, cross-sectional study included 109,736 singleton preterm and term infants, with 4,535 presenting breech. The risk factors of singleton breech were calculated by using multiple logistic regression analysis based on a cohort design (4,535 breech, 103,484 cephalic presentation).

Results: The incidence of term singleton breech decreased from 8.34% to 2.17%, but overall breech cesarean rates ranged from 83.06% to 98.62%. Five independent predictors of breech presentation were identified-age (odds ratio [OR] 1.02; 95% confidence interval [CI] 1.01-1.02), gestational age (OR 0.85; 95% CI 0.83-0.86), uterine malformation (OR 9.47; 95% CI 6.77-13.25), myoma (OR 1.58; 95% CI 1.28-1.95), gestational diabetes mellitus (OR 1.26; 95% CI 1.06-1.49)--and included in the logistic model, which accurately predicted outcome.

Conclusion: The cesarean rate of breech birth is high in China. Several different maternal and infant characteristics appear to increase the risk of breech birth, suggesting that there might be several different biologic mechanisms leading to breech presentation.