Abstract
There is good evidence that vaginal delivery of term breech presentation is a safe option in well selected cases. However, regarding induction of labor in breech presentation, international guidelines are inconsistent and its safety is not clearly established. The main objective of this study was to evaluate if induction of labor for women with a breech presentation is a less safe option for infants than planned cesarean delivery. We performed a secondary analysis of the observational prospective multicenter PREMODA study, including all singleton breech deliveries after 37 weeks of gestation in 174 centers in France and Belgium (N=8075). We excluded women with spontaneous labor, scared uterus and intrauterine fetal death. Our study population consisted of women with either an induced labor or a planned cesarean delivery. The primary outcome was the composite criteria of neonatal mortality and serious morbidity used in the Term Breech Trial and in the PREMODA prospective cohort assessing mode of delivery for breech presentations. Our study population consisted of 4138 women, 218 with an induction of labor and 3920 with a planned cesarean. Two-third (67.4%) of the women in the induction of labor group delivered vaginally. There was no significant difference between the two groups for the primary outcome (48 (1.2%) in the planned cesarean group versus 3 (1.4%) in the induction of labor group, p=0.75). None of the criteria of the composite primary outcome was significantly more frequent in the induction of labor group (Table). Induction of labor for breech presentation does not seem to increase neonatal mortality or severe neonatal morbidity compared to a planned cesarean delivery. It appears to be a safe and effective option in the cases of breech presentations with no spontaneous labor and no contraindications to vaginal delivery.
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