Is planned vaginal delivery for breech presentation at term still an option? Results of an observational prospective survey in France and Belgium

INSERM U149, Epidemiological Research Unit on Perinatal Health and Women's Health, Université Pierre et Marie Curie Paris VI, Hôpital Tenon, France.
American journal of obstetrics and gynecology (Impact Factor: 4.7). 05/2006; 194(4):1002-11. DOI: 10.1016/j.ajog.2005.10.817
Source: PubMed


A large trial published in 2000 concluded that planned vaginal delivery of term breech births is associated with high neonatal risks. Because the obstetric practices in that study differed from those in countries where planned vaginal delivery is still common, we conducted an observational prospective study to describe neonatal outcome according to the planned mode of delivery for term breech births in 2 such countries.
Observational prospective study with an intent-to-treat analysis to compare the groups for which cesarean and vaginal deliveries were planned. Associations between the outcome and planned mode of delivery were controlled for confounding by multivariate analysis. The main outcome measure was a variable that combined fetal and neonatal mortality and severe neonatal morbidity. The study population consisted of 8105 pregnant women delivering singleton fetuses in breech presentation at term in 138 French and 36 Belgian maternity units.
Cesarean delivery was planned for 5579 women (68.8%) and vaginal delivery for 2526 (31.2%). Of the women with planned vaginal deliveries, 1796 delivered vaginally (71.0%). The rate of the combined neonatal outcome measure was low in the overall population (1.59%; 95% CI [1.33-1.89]) and in the planned vaginal delivery group (1.60%; 95% CI [1.14-2.17]). It did not differ significantly between the planned vaginal and cesarean delivery groups (unadjusted odds ratio = 1.10, 95% CI [0.75-1.61]), even after controlling for confounding variables (adjusted odds ratio = 1.40, 95% CI [0.89-2.23]).
In places where planned vaginal delivery is a common practice and when strict criteria are met before and during labor, planned vaginal delivery of singleton fetuses in breech presentation at term remains a safe option that can be offered to women.

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    • "The frequency of vaginal breech deliveries decreased abruptly after publication of the Term Breech Trial [2], which stated that perinatal mortality, serious neonatal morbidity, and neonatal mortality were significantly higher in vaginal breech deliveries than in planned cesarean deliveries. However, vaginal breech delivery is still an acceptable option in the presence of a skilled obstetrician and if strict selection criteria regarding the conditions for a vaginal breech delivery are applied [3] [4]. "
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    ABSTRACT: Objective To evaluate the delivery route and the indications for cesarean delivery after successful external cephalic version (ECV). Methods A retrospective matched case–control study was conducted at a hospital in Lisbon, Portugal, between 2002 and 2012. Each woman who underwent successful ECV (n=44) was compared with the previous and next women who presented for labor management and who had the same parity and a singleton vertex pregnancy at term (n=88). The outcome measures were route of delivery, indications for cesarean delivery, and incidence of nonreassuring fetal status. Results Attempts at ECV were successful in 62 (46%) of 134 women, and 44 women whose fetuses remained in a cephalic presentation until delivery were included in the study. The rates of intrapartum cesarean delivery and operative vaginal delivery did not differ significantly between cases and controls (intrapartum cesarean delivery, 9 [20%] vs 16 [18%], P= 0.75; operative vaginal delivery, 14 [32%] vs 19 [22%], P= 0.20). The indications for cesarean delivery after successful ECV did not differ; in both groups, cesarean delivery was mainly performed for labor arrest disorders (cases, 6 [67%] vs controls, 13 [81%]; P= 0.63). Conclusion Successful ECV was not associated with increased rates of intrapartum cesarean delivery or operative vaginal delivery.
    International Journal of Gynecology & Obstetrics 09/2014; 126(3). DOI:10.1016/j.ijgo.2014.03.029 · 1.54 Impact Factor
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    • "Most studies of term breech deliveries are retrospective and based on registry data, which make comparisons difficult because of lack of antenatal and postnatal information. Our study is in terms of design comparable to a large prospective observation study from France/Belgium that included 8105 women [17], According to that study, vaginal delivery of breech infants remains standard practice in France. The proportion of planned vaginal deliveries was 51% in 1998 and decreased to 31% in the study period (2001–2002). "
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    ABSTRACT: Most countries recommend planned cesarean section in breech deliveries, which is considered safer than vaginal delivery. As one of few countries in the western world Norway has continued to practice planned vaginal delivery in selected women. The aim of this study is to evaluate prospectively registered neonatal and maternal outcomes in term singleton breech deliveries in a Norwegian hospital during a ten years period. We aim to compare maternal and neonatal outcomes in term breech pregnancies subjected either to planned vaginal or elective cesarean section. A prospective registration study including 568 women with term breech deliveries (>37 weeks) consecutively registered at Sorlandet Hospital Kristiansand between 2001 and 2011. Fetal and maternal outcomes were compared according to delivery method; planned vaginal delivery versus planned cesarean section. Of 568 women, elective cesarean section was planned in 279 (49%) cases and vaginal delivery was planned in 289 (51%) cases. Acute cesarean section was performed in 104 of the planned vaginal deliveries (36.3%). There were no neonatal deaths. Two cases of serious neonatal morbidity were reported in the planned vaginal group. One infant had seizures, brachial plexus injury, and cephalhematoma. The other infant had 5-minutes Apgar < 4. Twenty-nine in the planned vaginal group (10.0%) and eight in the planned cesarean section group (2.9%) (p < 0.001) were transferred to the neonatal intensive care unit. However, only one infant was admitted for >=4 days. According to follow-up data (median six years) none of these infants had long-term sequelae. Regarding maternal morbidity, blood loss was the only variable that was significantly higher in the planned cesarean section group versus in the vaginal delivery group (p < 0.001). Strict guidelines were followed in all cases. There were no neonatal deaths. Two infants had serious neonatal morbidity in the planned vaginal group without long-term sequelae.
    BMC Pregnancy and Childbirth 07/2013; 13(1):153. DOI:10.1186/1471-2393-13-153 · 2.19 Impact Factor
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    • "L'accouchement par siège représente 3 % des grossesses singleton à terme [1], 2,92 % de la totalité des accouchements dans notre maternité. La qualité des résultats néonataux dépend en grande partie du maintien de l'apprentissage des manoeuvres obstétricales et de l'application de protocoles déterminés en fonction des conditions techniques et humaines disponibles dans chaque maternité [1]. L'analyse d'une année de pratique au sein d'une maternité marocaine de niveau III montre une différence statistique significative entre les deux voies d'accouchement avec un bon pronostic néonatal en cas de césarienne en analyse univariée. "
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    ABSTRACT: Objectives The aim of our study was to evaluate the influence of the mode of delivery in breech presentation on the Apgar score, as well as its related transfers to the NICU at a level III Moroccan university maternity unit. Materials and Methods Our prospective study was conducted over a period of 1 year (January 2009–December 2009). Four hundred and twenty-seven neonates met our inclusion criteria. The main analysis criteria were Apgar scores, transfers to the NICU and neonatal morbidity associated with the mode of delivery. Results In univariate analysis, the C-section is accompanied by a lower rate of hospitalizations and a lower morbidity. In multivariate analysis, hospitalizations are correlated to both gestational age and multiple gestations. Conclusion In our work, both multiple gestation and prematurity were risk factors increasing hospitalizations rate. Another study including term pregnancies and singletons would be highly recommended to evaluate our actions.
    Journal de Pédiatrie et de Puériculture 02/2013; 26(1):19–24. DOI:10.1016/j.jpp.2012.11.002
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