[Term-breech presentation: predictive factors of cesarean section for vaginal-birth failure].

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.

• Authors: D-E Broche, R Ramanah, A Collin, M Mangin, C Vidal, R Maillet, D Riethmuller
• Journal: Journal de gynecologie, obstetrique et biologie de la reproduction (J Gynecol Obstet Biol Reprod (Paris)) Vol. 37 Issue 5 Pg. 483-92 (Sep 2008) ISSN: 0368-2315 [Print] France
• Vernacular Title: Présentation du siège à terme: facteurs prédictifs de césarienne en cours de travail.
• PMID: 18584974 (Publication Type: English Abstract, Journal Article)

Topics

• 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