Educational outcomes following breech delivery: a record-linkage study of 456 947 children

Background: Obstetric management of term breech infants changed dramatically following the Term Breech Trial which suggested increased serious neonatal morbidity following trial of labour. Short-term morbidity is a poor proxy of long-term neurological sequelae. We determined whether vaginal breech delivery was associated with educational outcomes. Methods: We linked three Scotland-wide administrative databases at an individual level: the ScotXed school census; Scottish Qualifications Authority (SQA) examination results; and Scottish Morbidity Record (SMR02) maternity database. The linkage provided information on singleton children, born at term, attending Scottish schools between 2006 and 2011. Results: Of the 456 947 eligible children, 1574 (0.3%) had vaginal breech deliveries, 12 489 (2.7%) planned caesarean section for breech presentation and 442 090 (96.9%) vaginal cephalic deliveries. The percentage of term breech infants delivered vaginally fell from 23% to 7% among children who started school in 2006 and 2011, respectively. Of children born by vaginal breech delivery, 1.5% had a low 5-min Apgar score (<= 3) compared with only 0.4% of those born by either breech caesarean section [adjusted odds ratio (OR) 6.16, 95% confidence interval (Cl) 4.44-8.54, p<0.001] or cephalic vaginal delivery (adjusted OR 3.84, 95% Cl 2.99-4.93, p< 0.001). Children born by vaginal breech delivery had lower examination attainment than those born by either planned caesarean section for breech presentation (adjusted OR 1.16, 95% Cl 1.02-1.32, p=0.020) or vaginal cephalic delivery (adjusted OR 1.14, 95% Cl 1.01-1.28, p=0.029). Conclusions: Vaginal delivery of term breech infants was associated with lower examination attainment, as well as poorer Apgar scores, suggesting that the adverse effects are not just short-term.