The influence of the fetal leg position on the outcome in vaginally intended deliveries out of breech presentation at term – A FRABAT prospective cohort study


Autoři: Lukas Jennewein aff001;  Roman Allert aff001;  Charlotte J. Möllmann aff001;  Bettina Paul aff001;  Ulrikke Kielland-Kaisen aff001;  Florian J. Raimann aff002;  Dörthe Brüggmann aff001;  Frank Louwen aff001
Působiště autorů: FRABAT FRAnkfurt Breech At Term Study Group; Department of Gynecology and Obstetrics, School of Medicine, Goethe-University, Theodor-Stern-Kai 7, Frankfurt, Germany aff001;  Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany aff002
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225546

Souhrn

Introduction

Vaginal delivery out of a breech presentation in pregnancies at term are being re-implemented into clinical practice. Still, recommendations regarding exclusion criteria leading to caesarean sections are based on expert opinions, not on evidence-based guidelines. The difference in perinatal outcome and course of delivery in births with babies in frank breech position and babies in incomplete or complete breech presentation never has been investigated in a large patient cohort.

Objective

To compare perinatal outcome of vaginally intended breech deliveries between births out of frank breech position and incomplete/complete breech presentation.

Design

Prospective cohort study.

Sample

884 women at term with a singleton in frank breech presentation (FB) and 284 women with incomplete or complete breech presentation (CB) intending vaginal birth between January 2004 and December 2018.

Methods

Maternal and fetal outcome was compared between groups using Pearson’s Chi Square test. Birth duration parameters were analysed using logistic regression.

Results

There were no differences in cesarean section rates (FB: 25.1%, CB 22.2%, p = 0.317). Short-term fetal morbidity did not differ between groups (FB: 2.5%, CB: 2.8%, p = 0.761). In vaginal deliveries the necessity to perform manual assistance was significantly more frequent in deliveries of infants in CB (FB: 39.9%, CB: 51.6%, p = 0.0013). Cord loops (FB: 10.1%, CB: 18.0%, p = 0.0004) and cesarean sections necessary because of cord prolapses (FB: 1.4%, CB 8.1%, p = 0.005) were significantly more often in deliveries with babies in CB.

Conclusion

This study provides evidence, that perinatal morbidity is not associated with the fetal leg posture in vaginally intended breech deliveries. The higher risk for the need of manual assistance during vaginal birth in deliveries of babies out of complete or incomplete breech presentation suggests that obstetrical departments re-implementing the vaginal breech in their repertoire might start with births of babies out of frank breech presentation.

Klíčová slova:

Asphyxia – Cesarean section – Labor and delivery – Legs – Morbidity – Neonates – Pregnancy – Umbilical cord


Zdroje

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2019 Číslo 12