Is induction of labor a reasonable option for breech presentation?

Abstract

Introduction Whereas spontaneous onset of labor and vaginal delivery for breech presentation is considered to be a safe and effective option in selected cases, the safety of induction of labor is not established yet. The objectives of this study were to describe the outcomes of pregnancy in women induced with a fetus in breech presentation and compare the outcomes with those undergoing planned cesarean delivery. Material and methods We performed a secondary analysis of the observational prospective multicenter PREMODA study, including all singleton breech deliveries after 37 weeks in 174 centers in France and Belgium. We excluded women with spontaneous onset of labor, scarred uterus or intrauterine fetal death. Our study population consisted of women with either induction of labor or 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. Results Our study population consisted of 4138 women, 218 with induction of labor and 3920 with planned cesarean. Two‐thirds (67.4%) of the women in the induction of labor group delivered vaginally. There was no significant difference between the groups for the primary outcome (48 [1.2%] in the planned cesarean group vs 3 [1.4%] in the induction of labor group, P = 0.75). Moreover, none of the criteria of the composite primary outcome was significantly more frequent in the induction of labor group. Conclusions Induction of labor for breech presentation does not seem to increase neonatal mortality or severe neonatal morbidity compared with planned cesarean delivery.

Risk factors for adverse outcomes in vaginal preterm breech labor

“…However, Macharey et al found no association between induction of term breech labor and neonatal morbidity, but the rate of vaginal deliveries was remarkably lower if term breech labor was induced compared to the spontaneous breech deliveries [29]. Induction of term labor in breech presentation was established as safe as planned cesarean delivery also in observational prospective study 2019 [30].…”

Mode of vaginal delivery in breech presentation and perinatal outcome

“…Induction of labor in breech presentation has rarely, but recently, been reported. Finnish authors published a retrospective observational study of induction of labor in breech presentation [29]. Results showed no statistical differences between the induction group and the spontaneous group regarding neonatal and maternal morbidity and mortality.…”

“…Results showed that there was no significant difference between the groups for the primary neonatal outcome in the planned caesarean section versus in the induction of labor. Consequently, the induction of labor might be an additional tool after unsuccessful external version to prevent a primary caesarean section [29][30][31].…”

Preterm Severe Neonatal Morbidity and Mortality in Breech Presentation Regarding the Onset Mode of Labor

“…(17) (18) We used as a primary outcome a composite criterion extracted from former publications and that we reviewed for the preterm fetuses population. (4) ( 19) (20) We used propensity score analysis to minimize the likelihood of incorrectly attributing any risk of neonatal morbidity to onset of labor, which is an inherent di culty in this study.…”