Is planned vaginal delivery for breech presentation at term still an option? Results of an observational prospective survey in France and Belgium (original) (raw)
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Acta Obstetricia et Gynecologica Scandinavica, 2022
IntroductionThree per cent of all infants are born in breech presentation, still the preferred way to deliver them remains controversial. The objective of this systematic review was to assess the safety for the mother and child depending on intended mode of delivery when the baby is in breech position at term.Material and MethodsThe population (P) was pregnant women with a child in breech presentation, from gestational week 34+0. The intervention (I) was the intention to deliver by cesarean section, the comparison (C) was the intention to deliver vaginally. Outcomes (O) were perinatal mortality, perinatal morbidity, maternal mortality, maternal morbidity, conversion of delivery mode, and the mother's experience. Systematic literature searches were performed. We included randomized trials, cohort studies with more than 500 women/group and case series for more than 15 000 women published between 1990 and October 2021, written in English or the Nordic languages. The certainty of evidence was assessed using the GRADE approach and data were pooled in meta‐analyses. PROSPERO registration number: CRD42020209546.ResultsThirty‐two articles were included (with 530 604 women). The certainty of evidence was moderate or low because the study designs were mostly retrospective cohort studies. The only randomized trial showed reduced risk of perinatal mortality for planned cesarean section, risk ratio (RR) 0.27 (95% confidence interval [CI] 0.08–0.97, 2078 women, low certainty of evidence), stillbirths excluded. A meta‐analysis of cohort studies resulted in a similar estimate, RR 0.36 (95% CI 0.25–0.51, 21 studies, 388 714 women, low certainty of evidence). We also found reduced risk for outcomes representing perinatal morbidity 0–28 days: 5‐min Apgar score less than 7 in one randomized controlled trial: RR 0.27 (95% CI 0.12–0.58, 2033 women, moderate certainty of evidence), and in a meta‐analysis: RR 0.1 (95% CI 0.14–0.26, 18 studies, 217 024 women, moderate certainty of evidence); APGAR score less than 4 at 5 min: RR 0.39 (95% CI 0.19–0.81, five studies, 44 498 women, low certainty of evidence); and pH less than 7.0: RR 0.23 (95% CI 0.12–0.43, four studies, 13 440 women, low certainty of evidence). Outcomes for the mother were similar in the groups except for reduced risk for experience of urinary incontinence in the group of planned cesarean section: RR 0.62 (95% CI 0.41–0.93, one study, 1940 women, low certainty of evidence). The conversion rate from planned vaginal delivery to emergency cesarean section ranged from 16% to 51% (median 41.8%, 10 studies, 50 763 women, moderate certainty of evidence).ConclusionsIntended cesarean section may reduce the risk of perinatal mortality and perinatal as well as some maternal morbidity compared with intended vaginal delivery. It is uncertain whether there is any difference in maternal mortality. The conversion rate from intended vaginal delivery to emergency cesarean section is high.
2002
for the Term Breech Trial 3-Month Follow-up Collaborative Group R ATES OF CESAREAN DELIVERY vary tremendously in different settings, and recent data suggest that rates are generally increasing. 1-4 The procedure is usually undertaken to reduce the risk of adverse outcomes for the neonate, accepting that maternal risk of complications may be higher. The Term Breech Trial, a multicenter, international, randomized controlled trial of 2088 women, was undertaken to determine if a policy of planned cesarean delivery, compared with planned vaginal birth, would decrease the risk of adverse perinatal outcomes, a composite measure of perinatal or neonatal mortality or serious neonatal morbidity, for the selected fetus in breech presenta
Obstetrical & Gynecological Survey, 2002
for the Term Breech Trial 3-Month Follow-up Collaborative Group R ATES OF CESAREAN DELIVERY vary tremendously in different settings, and recent data suggest that rates are generally increasing. 1-4 The procedure is usually undertaken to reduce the risk of adverse outcomes for the neonate, accepting that maternal risk of complications may be higher. The Term Breech Trial, a multicenter, international, randomized controlled trial of 2088 women, was undertaken to determine if a policy of planned cesarean delivery, compared with planned vaginal birth, would decrease the risk of adverse perinatal outcomes, a composite measure of perinatal or neonatal mortality or serious neonatal morbidity, for the selected fetus in breech presenta
Acta medica portuguesa, 2017
The best route of delivery for the term breech fetus is still controversial. We aim to compare maternal and neonatal outcomes between vaginal and cesarean term breech deliveries. Multicentric retrospective cohort study of singleton term breech fetuses delivered vaginally or by elective cesarean section from January 2012 - October 2014. Primary outcomes were maternal and neonatal morbidity or mortality. Sixty five breech fetuses delivered vaginally were compared to 1262 delivered by elective cesarean. Nulliparous women were more common in the elective cesarean group (69.3% vs 24.6%; p < 0.0001). Gestational age at birth was significantly lower in the vaginal delivery group (38 ± 1 weeks vs 39 ± 0.8 weeks; p = 0.0029) as was birth weight (2928 ± 48.4 g vs 3168 ± 11.3 g; p < 0.0001). Apgar scores below seven on the first and fifth minutes were more likely in the vaginal delivery group (1st minute: 18.5% vs 5.9%; p = 0.0006; OR 3.6 [1.9 - 7.0]; 5th minute: 3.1% vs 0.2%; p = 0.0133...
Journal of Global Health, 2022
Background Breech presentation delivery approach is a controversial issue in obstetrics. How to cope with breech delivery (vaginal or C-section) has been discussed to find the safest in terms of morbidity. The aim of this study was to assess the risks of foetal and maternal mortality and perinatal morbidity associated with vaginal delivery against elective caesarean in breech presentations, as reported in observational studies. Methods Studies assessing perinatal morbidity and mortality associated with breech presentations births. Cochrane, Medline, Scopus, Embase, Web of Science, and Cuiden databases were consulted. This protocol was registered in PROSPERO CRD42020197598. Selection criteria were: years between 2010 and 2020, in English language, and full-term gestation (37-42 weeks). The methodological quality of the eligible articles was assessed according to the Newcastle-Ottawa scale. Meta-analyses were performed to study each parameter related to neonatal mortality and maternal morbidity. Results The meta-analysis included 94 285 births with breech presentation. The relative risk of perinatal mortality was 5.48 (95% confidence interval (CI) = 2.61-11.51) times higher in the vaginal delivery group, 4.12 (95% CI = 2.46-6.89) for birth trauma and 3.33 (95% CI = 1.95-5.67) for Apgar results. Maternal morbidity showed a relative risk 0.30 (95% CI = 0.13-0.67) times higher in the planned caesarean group. Conclusions An increment in the risk of perinatal mortality, birth trauma, and Apgar lower than 7 was identified in planned vaginal delivery. However, the risk of severe maternal morbidity because of complications of a planned caesarean was slightly higher.
Acta Obstetricia et Gynecologica Scandinavica, 2014
The aim of this study was to evaluate the effect of the increased cesarean rate for term breech presentation on neonatal outcome. We also investigate whether the clinical case selection for vaginal delivery applied by Dutch obstetricians led to an optimization of neonatal outcome, or if there is still room for improvement in terms of perinatal outcome. Design Retrospective cohort. Setting the Netherlands. Population Singleton term breech deliveries from 37 0/7 to 41 6/7 weeks, excluding fetus with congenital malformations or antenatal death. Method We used data from the Dutch national perinatal registry from 1999 up to 2007. Main outcome measures Perinatal mortality and morbidity. Results We studied 58,320 women with a term breech delivery. There was an increase in the elective cesarean rate (from 24% to 60%). As a consequence, overall perinatal mortality decreased (1.3 vs. 0.7‰; OR 0.51 (95% CI 0.28-0.93)), while it remained stable in the planned vaginal birth group (1.7 vs. 1.6‰; OR 0.96 (95% CI 0.52-1.76)). The number of caesareans to prevent one perinatal death was 338. Conclusions Adjustment of the national guidelines after publication of the Term Breech Trial resulted in a shift towards elective cesarean and a decrease of perinatal mortality and morbidity among women delivering a child in breech at term. Still 40% of these women attempt vaginal birth. The relative safety of an elective cesarean should be weighed against the consequences of a scarred uterus in future pregnancies.