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

Abstract

PurposeThe objective was to assess neonatal severe morbidity in case of cervical ripening, in premature breech fetuses, comparatively at spontaneous labor. MethodsThis is a retrospective study conducted in a tertiary center.Women with alive singleton breech between 28 and 36+6 weeks of gestation were considered. We compared women with an unfavorable cervix, who had an indication to deliver, to women in spontaneous labor.The primary outcome was a composite morbi-mortality criterion including perinatal death, traumatic event, 5-min Apgar < 4, moderate / severe encephalopathy, seizures, Intra Ventricular Hemorrhage grade 3-4, necrotizing enterocolitis grade 2-3. The association between the onset of labor and severe neonatal morbidity was assessed by logistic regression model. A propensity score approach with inverse probability of treatment weighting was performed to control indication bias. ResultsWe included 212 patients: 64 in the induced labor group and 136 in the spontaneous labor group. Labor was induced mostly for fetal growth restriction (34.4%), oligoamnios (18.7%) and pre-eclampsia (18.7%). When induced labor, 45.3% of patients delivered vaginally, and 86% when spontaneous labor.The rate of neonatal morbidity was similar in two groups (4.7% versus 5.2%, p=0.889). There was no association between the onset of labor and severe neonatal morbidity (OR 0.99, 95% CI 0.2-3.6)). After applying propensity scores, induction of labor was not associated with improved severe neonatal morbidity (OR 0.9, 95% IC 0.4-2.5).ConclusionThe onset mode of labor do not seem to have an effect on severe neonatal morbidity and mortality in preterm breech fetuses.