Abstract
To determine whether there was any difference in neonatal and maternal outcomes between breech vaginal delivery and cephalic vaginal delivery. A retrospective, case-control study was conducted between January 2015 and December 2017 in a Portuguese hospital. A total of 26 cases of breech vaginal delivery were considered eligible and 52 pregnant women formed the control group. Induced labor was more frequent in the breech vaginal delivery group (46% versus 21%, p = 0.022). Episiotomy was more common in the breech vaginal delivery group (80% versus 52%, p = 0.014), and one woman had a 3rd degree perineal laceration. Newborns in the study group had a lower birthweight (2,805 g versus 3,177 g, p < 0.001). There was no significant difference in the neonatal outcomes. The present study showed that breech vaginal delivery at term compared with cephalic presentation was not associated with significant differences in neonatal and maternal morbidity. It also suggests that breech vaginal delivery remains a safe option under strict selection criteria and in the presence of an experienced obstetrician.
Highlights
Breech presentation occurs in between 3 and 4% of term deliveries.[1]
The present study showed that breech vaginal delivery at term compared with cephalic presentation was not associated with significant differences in neonatal and maternal morbidity
It suggests that breech vaginal delivery remains a safe option under strict selection criteria and in the presence of an experienced obstetrician
Summary
Breech presentation occurs in between 3 and 4% of term deliveries.[1]. The best route of delivery is still controversial, but the safety of vaginal breech delivery is the main concern. The analysis by Glezerman revealed some of these: violation of inclusion criteria such as inclusion of fetus with hyperextended head or > 4,000 g in the planned vaginal delivery; substantially different levels of standard of care between the participating centers and, important, > 20% of the planned vaginal deliveries were performed by a less skilled obstetrician.[3] On the other hand, the PREsentation et MODe d’Accouchement (PREMODA) study, a prospective observational multicenter study conducted in 174 centers in France and Belgium including 8,105 singleton breech fetuses at term, showed that a composite outcome of fetal/neonatal mortality or serious neonatal morbidity was not significantly different for planned vaginal versus planned cesarean delivery (1.60% versus 1.45%, odds ratio [OR] 1.10, 95% confidence interval [CI]: 0.75–1.61).[4] cesarean delivery was associated with several maternal morbidities, such as hemorrhage that requires hysterectomy or transfusion, uterine rupture, anesthetic complications, shock, cardiac arrest, acute renal failure, assisted ventilation, venous thromboembolism, major infection, or in-hospital wound disruption or hematoma; and long-term risks, especially those associated with subsequent pregnancies, such as placental disorders.[5] Most of the studies published, either retrospective or prospective, compare vaginal breech delivery with planned or intrapartum cesarean delivery. The present study was designed to determine whether there was any difference in neonatal and maternal outcomes between breech vaginal delivery and cephalic vaginal delivery in a selected population
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