Malpresentation in low- and middle-income countries: Associations with perinatal and maternal outcomes in the Global Network

the NICHD Global Network for Women's and Children's Health Research

Research output: Contribution to journalArticlepeer-review

14 Citations (Scopus)

Abstract

Introduction: Uncertainty exists regarding the impact of malpresentation on pregnancy outcomes and the optimal mode of delivery in low- and middle-income countries. We sought to compare outcomes between cephalic and non-cephalic pregnancies. Material and methods: Using the NICHD Global Network's prospective, population-based registry of pregnancy outcomes from 2010 to 2016, we studied outcomes in 436 112 singleton pregnancies. Robust Poisson regressions were used to estimate the risk of adverse outcomes associated with malpresentation. We examined rates of cesarean delivery for malpresentation and compared outcomes between cesarean and vaginal delivery by region. Results: Across all regions, stillbirth and neonatal mortality rates were higher among deliveries with malpresentation. In adjusted analysis, malpresentation was significantly associated with stillbirth (adjusted relative risk [aRR] 4.0, 95% confidence interval [CI] 3.7-4.5) and neonatal mortality (aRR 2.3, 95% CI 2.1-2.6). Women with deliveries complicated by malpresentation had higher rates of morbidity and mortality. Rates of cesarean delivery for malpresentation ranged from 27% to 87% among regions. Compared with cesarean delivery, vaginal delivery for malpresentation was associated with increased maternal risk, especially postpartum hemorrhage (aRR 5.0, 95% CI; 3.6-7.1). Conclusions: In a cohort of deliveries in low- and middle-income countries, malpresentation was associated with increased perinatal and maternal risk. Further research is needed to determine the best management of these pregnancies.

Original languageEnglish
Pages (from-to)300-308
Number of pages9
JournalActa Obstetricia et Gynecologica Scandinavica
Volume98
Issue number3
DOIs
Publication statusPublished - Mar 2019

Keywords

  • breech presentation
  • cesarean section
  • developing countries
  • labor presentation
  • obstetric delivery
  • pregnancy outcomes

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