[Term-breech Presentation: Predictive Factors of Cesarean Section for Vaginal-Birth Failure]

J Gynecol Obstet Biol Reprod (Paris). 2008 Sep;37(5):483-92. doi: 10.1016/j.jgyn.2008.03.011. Epub 2008 Jun 26.
[Article in French]

Abstract

Objectives: In our maternity ward, vaginal-breech birth is favoured when the protocol for patient's eligibility is respected. But in our practice, 20% patients have a cesarean section during labor for vaginal-birth failure, with a higher rate of neonatal and maternal morbidities. This study tried to consider if some obstetrical elements, not usually used, could help select the candidates in a more efficient way.

Patients and methods: This retrospective study included all the singleton-breech deliveries with a gestational age over 37 weeks in our maternity ward from 1994 to 2004. An analysis of obstetrical elements, available before and during labour, has been carried out.

Results: Three hundred and seventy-six deliveries were indexed for a vaginal-birth trial. We carried out a cesarean section in 21.3% cases. We have found five obstetrical elements, not used in the vaginal birth protocol, which were significant risk factors for a cesarean section: nulliparity (OR=0.25 [0.11-0.57]), maternal height (OR=0.56 [0.30-1.03]), ultrasound estimated fetal weight (OR=7.76 [2.29-26.28]), fundal height (OR=3.9 [2.41-8.62]) and dystocia in first stage of labour (OR=4.97 [2.67-9.25]).

Discussion: A cesarean section during labor is responsible for a high-morbidity rate. We have to reduce this obstetrical event, especially in breech presentation, by a better selection of patients. From this study, we have created a statistical model to screen patients, but we have to lead a prospective study to validate it.

Publication types

  • English Abstract

MeSH terms

  • Breech Presentation / surgery*
  • Cesarean Section / methods*
  • Delivery, Obstetric / methods
  • Female
  • Gestational Age
  • Humans
  • Odds Ratio
  • Pregnancy
  • Pregnancy Outcome
  • Prognosis
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Trial of Labor