1118: Cesarean delivery for breech presentation as a risk-factor for long-term gastrointestinal morbidity of the offspring

Established results from the Term Breech Trial motivated practitioners to prefer planned cesarean for breech presentation in order to minimize the risks for the neonate attributed to vaginal delivery. To further assess the implications of mode of delivery on offspring's health, we have evaluated the-long term gastrointestinal (GI) morbidity of those delivered in either way. A population-based cohort study was performed including singleton deliveries in breech presentation occurring between 1991 and 2014 at a tertiary referral hospital. Incidence of hospitalizations of the offspring up to the age of 18 years involving GI morbidity was compared between those delivered via cesarean delivery (CD) or vaginally. A Kaplan Meier survival curve compared cumulative GI morbidity. A Weibull parametric survival model controlled for confounders while accounting for repeated occurrence of mothers and dependence among siblings. Of the 7337 deliveries in breech presentation that met the inclusion criteria, 86.9% were delivered by CD (n=6376) and the rest delivered vaginally. Hospitalizations involving GI morbidity were significantly higher in offspring delivered by CD, specifically due to inflammatory bowel disease and inguinal or umbilical hernias (Table). Additionally, the Kaplan Meier survival curve revealed higher cumulative incidence of GI morbidity in the CD group (Figure, log rank test p< 0.001). Using a Weibull parametric survival model while controlling for gestational age, maternal age, parity, ethnicity, gestational diabetes mellitus, prenatal care, neonatal gender and birth weight, CD was noted as an independent risk factor for long term gastrointestinal morbidity of the offspring (adjusted HR=1.94, CI 95% 1.39-2.71, p< 0.001). While robust evidence suggests that planned CD is preferable in terms of lowering neonatal morbidity and mortality, our study does not provide support that these associations continue beyond the neonatal period, as reflected in higher rates of GI morbidly among children delivered by CD.View Large Image Figure ViewerDownload Hi-res image Download (PPT)