Revisiting the management of term breech presentation: a proposal for overcoming some of the controversies

Lionel Carbillon, Amelie Benbara, Ahmed Tigaizin, Rouba Murtada, Marion Fermaut, Fatma Belmaghni, Alexandre Bricou, Jeremy Boujenah, Lionel Carbillon, Amelie Benbara, Ahmed Tigaizin, Rouba Murtada, Marion Fermaut, Fatma Belmaghni, Alexandre Bricou, Jeremy Boujenah

Abstract

Background: The debate surrounding the management of term breech presentation has excessively focused on the mode of delivery. Indeed, a steady decline in the rate of vaginal breech delivery has been observed over the last three decades, and the soundness of the vaginal route was seriously challenged at the beginning of the 2000s. However, associations between adverse perinatal outcomes and antenatal risk factors have been observed in foetuses that remain in the breech presentation in late gestation, confirming older data and raising the question of the role of these antenatal risk factors in adverse perinatal outcomes. Thus, aspects beyond the mode of delivery must be considered regarding the awareness and adequate management of such situations in term breech pregnancies.

Main body: In the context of the most recent meta-analysis and with the publication of large-scale epidemiologic studies from medical birth registries in countries that have not abruptly altered their criteria for individual decision-making regarding the breech delivery mode, the currently available data provide essential clues to understanding the underlying maternal-foetal conditions beyond the delivery mode that play a role in perinatal outcomes, such as foetal growth restriction and gestational diabetes mellitus. In view of such data, an accurate evaluation of these underlying conditions is necessary in cases of persistent term breech presentation. Timely breech detection, estimated foetal weight/growth curves and foetal/maternal well-being should be considered along with these possible antenatal risk factors; a thorough analysis of foetal presentation and an evaluation of the possible benefit of external cephalic version and pelvic adequacy in each specific situation of persistent breech presentation should be performed.

Conclusion: The adequate management of term breech pregnancies requires screening and the efficient identification of breech presentation at 36 weeks of gestation, followed by thorough evaluations of foetal weight, growth and mobility, while obstetric history, antenatal gestational disorders and pelvis size/conformation are considered. The management plan, including external cephalic version and follow-up based on the maternal/foetal condition and potentially associated disorders, should be organized on a case-by-case basis by a skilled team after the woman is informed and helped to make a reasoned decision regarding delivery route.

Keywords: Delivery route; Foetal growth restriction; Oligohydramnios; Pelvimetry; Perinatal morbidity; Perinatal mortality; Severe maternal morbidity; Small-for-gestational-age; Term breech delivery.

Conflict of interest statement

The authors declare that they have no competing interests.

References

    1. Trends in vaginal breech delivery. J Epidemiol Community Health. 2015;69:1237–9.
    1. Hannah ME, Hannah WJ, Hewson SA, Hodnett ED, Saigal S, Willan AR. Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomized multicentre trial. Term Breech Trial Collaborative Group Lancet. 2000;356(9239):1375–1383.
    1. RCOG . Setting standards to improve women’s health. 2001.
    1. ACOG committee opinion: number 265, December 2001 Mode of term single breech delivery. Committee on Obstetric Practice. Obstet Gynecol. 2001;98:1189–1190.
    1. Rietberg CC, Elferink-Stinkens PM, Visser GH. The effect of the term breech trial on medical intervention behaviour and neonatal outcome in the Netherlands: an analysis of 35,453 term breech infants. BJOG. 2005;112:205–209.
    1. Glezerman M. Five years to the term breech trial: the rise and fall of a randomized controlled trial. Obstet Gynecol. 2015;125:1162–1167.
    1. Kotaska A. Inappropriate use of randomised trials to evaluate complex phenomena: case study of vaginal breech delivery. BMJ. 2004;329(7473):1039–1042.
    1. Su M, McLeod L, Ross S, et al. Term Breech Trial Collaborative Group Factors associated with adverse perinatal outcome in the Term Breech Trial. Am J Obstet Gynecol. 2003;189:740–745.
    1. Whyte H, Hannah ME, Saigal S, et al. Term Breech Trial Collaborative Group. Outcomes of children at 2 years after planned cesarean birth versus planned vaginal birth for breech presentation at term: the International Randomized Term Breech Trial. Am J Obstet Gynecol. 2004;191:864–871.
    1. Su M, McLeod L, Ross S, et al. Factors associated with maternal morbidity in the term breech trial. J Obstet Gynaecol Can. 2007;29:324–330.
    1. Hartnack Tharin JE, Rasmussen S. Krebs L consequences of the term breech trial in Denmark. Acta Obstet Gynecol Scand. 2011;90:767–771.
    1. Vlemmix F, Bergenhenegouwen L, Schaaf JM, et al. Term breech deliveries in the Netherlands: did the increased cesarean rate affect neonatal outcome? A population-based cohort study. Acta Obstet Gynecol Scand. 2014;93:888–896.
    1. Schutte JM, Steegers EA, Santema JG, Schuitemaker NW, van Roosmalen J, Maternal Mortality Committee of the Netherlands society of obstetrics Maternal deaths after elective cesarean section for breech presentation in the Netherlands. Acta Obstet Gynecol Scand. 2007;86:240–243.
    1. van Dillen J, Zwart JJ, Schutte J, Bloemenkamp KW, van Roosmalen J. Severe acute maternal morbidity and mode of delivery in the Netherlands. Acta Obstet Gynecol Scand. 2010;89(11):1460–1465.
    1. Lyons J, Pressey T, Bartholomew S, Liu S, Liston R, Joseph KS. Delivery of breech presentation at term gestation, Canada, 2003 to 2011. Obstet Gynecol. 2015;125:1153–1161.
    1. Joseph KS, Pressey T, Lyons J, Bartholomew S, Liu S, Muraca G, et al. Once more unto the breech: planned vaginal delivery compared with planned cesarean delivery. Obstet Gynecol. 2015;125:1162–1167.
    1. Thornton JG. The term breech trial results are generalisable. BJOG. 2016;123(1):58.
    1. ACOG Committee Opinion No. 340 Mode of term singleton breech delivery. ACOG Committee on obstetric practice. Obstet Gynecol. 2006;108:235–237.
    1. SOGC clinical practice guideline: Vaginal delivery of breech presentation: no. 226, June 2009. Kotaska A, Menticoglou S, Gagnon R, Farine D, Basso M, Bos H, Delisle MF, Grabowska K, Hudon L, Mundle W, Murphy-Kaulbeck L, Ouellet A, Pressey T, Roggensack A. Society of Obstetricians and Gynaecologists of Canada. Int J Gynaecol Obstet. 2009;107:169–176.
    1. RCOG. Setting standards to improve women’s health. Guideline No. 20b. December 2006, actualized in March 2017.
    1. Berhan Y, Haileamlak A. The risks of planned vaginal breech delivery versus planned caesarean section for term breech birth: a meta-analysis including observational studies. BJOG. 2016;123:49–57.
    1. Macharey G, Gissler M, Rahkonen L, et al. Breech presentation at term and associated obstetric risks factors-a nationwide population based cohort study. Arch Gynecol Obstet. 2017;295:833–838.
    1. Macharey G, Gissler M, Ulander VM, et al. Risk factors associated with adverse perinatal outcome in planned vaginal breech labors at term: a retrospective population-based case-control study. BMC Pregnancy Childbirth. 2017;17:93.
    1. Bjellmo S, Andersen GL, Martinussen MP, et al. Is vaginal breech delivery associated with higher risk for perinatal death and cerebral palsy compared with vaginal cephalic birth? Registry-based cohort study in Norway. BMJ Open. 2017;7:e014979.
    1. Gardosi J, Madurasinghe V, Williams M, Malik A, Francis A. Maternal and fetal risk factors for stillbirth: population based study. BMJ. 2013;346:f108.
    1. Luterkort M, Persson PH, Weldner BM. Maternal and fetal factors in breech presentation. Obstet Gynecol. 1984;64:55–59.
    1. Krebs L, Topp M, Langhoff-Roos J. The relation of breech presentation at term to cerebral palsy. Br J Obstet Gynaecol. 1999;106:943–947.
    1. Fox AJ, Chapman MG. Longitudinal ultrasound assessment of fetal presentation: a review of 1010 consecutive cases. Aust N Z J Obstet Gynaecol. 2006;46:341–344.
    1. Hiersch L, Yeoshoua E, Miremberg H, et al. The association between Mullerian anomalies and short-term pregnancy outcome. J Matern Fetal Neonatal Med. 2016;29:2573–2578.
    1. Singh A, Mishra N, Dewangan R. Delivery in breech presentation: the decision making. J Obstet Gynaecol India. 2012;62:401–405.
    1. Ulander VM, Gissler M, Nuutila M, Ylikorkala O. Are health expectations of term breech infants unrealistically high? Acta Obstet Gynecol Scand. 2004;83:180–186.
    1. Goffinet F, Carayol M, Foidart JM, et al. Is planned vaginal delivery for breech presentation at term still an option? Results of an observational prospective survey in France and Belgium. Am J Obstet Gynecol. 2006;194:1002–1011.
    1. Van Loon AJ, Mantingh A, Serlier EK, Kroon G, Mooyaart EL, Huisjes HJ. Randomised controlled trial of magnetic-resonance pelvimetry in breech presentation at term. Lancet. 1997;350:1799–1780.
    1. Hoffmann J, Thomassen K, Stumpp P, Grothoff M, Engel C, Kahn T, Stepan H. New MRI Criteria for Successful Vaginal Breech Delivery in Primiparae. PLoS One. 2016;11:e0161028.
    1. Klemt AS, Schulze S, Brüggmann D, Louwen F. MRI-based pelvimetric measurements as predictors for a successful vaginal breech delivery in the Frankfurt breech at term cohort (FRABAT) Eur J Obstet Gynecol Reprod Biol. 2019;232:10–17.
    1. Toivonen E, Palomäki O, Huhtala H, Uotila J. Cardiotocography in breech versus vertex delivery: an examiner-blinded, cross-sectional nested case-control study. BMC Pregnancy Childbirth. 2016;16:319.
    1. Macharey G, Ulander VM, Heinonen S, Kostev K, Nuutila M, Väisänen-Tommiska M. Risk factors and outcomes in “well-selected” vaginal breech deliveries: a retrospective observational study. J Perinat Med. 2017;45:291–297.
    1. Goodin A, Delcher C, Valenzuela C, Wang X, Zhu Y, Roussos-Ross D, Brown JD. The power and pitfalls of big data research in obstetrics and gynecology: a Consumer's guide. Obstet Gynecol Surv. 2017;72:669–682.
    1. Vargha P, Fülöp V, Tabák ÁG. Breech presentation: its predictors and consequences. An analysis of the Hungarian Tauffer obstetric database (1996-2011) Acta Obstet Gynecol Scand. 2016;95:347–354.
    1. Hemelaar J, Lim LN, Impey LW. The impact of an ECV service is limited by antenatal breech detection: a retrospective cohort study. Birth. 2015;42:165–172.
    1. Bin YS, Roberts CL, Nicholl MC, Ford JB. Uptake of external cephalic version for term breech presentation: an Australian population study, 2002-2012. BMC Pregnancy Childbirth. 2017;17:244.
    1. Rosman AN, Guijt A, Vlemmix F, Rijnders M, Mol BW, Kok M. Contraindications for external cephalic version in breech presentation at term: a systematic review. Acta Obstet Gynecol Scand. 2013;92:137–142.
    1. Quist-Nelson J, Landers K, McCurdy R, Berghella V. External cephalic version in premature rupture of membranes: a systematic review. J Matern Fetal Neonatal Med. 2017;30:2257–2261.
    1. Burgos J, Cobos P, Rodríguez L, et al. Is external cephalic version at term contraindicated in previous caesarean section? A prospective comparative cohort study. BJOG. 2014;121:230–235.
    1. Traité du palper abdominal au point de vue obstétrical et de la version par manœuvres externes / par A. Pinard. PARIS H. LATJWEREYNS, LIBRAIRE-ÉDITEUR, 1878.
    1. Lau TK, Lo KW, Wan D, Rogers MS. Predictors of successful external cephalic version at term: a prospective study. Br J Obstet Gynaecol. 1997;104:798–802.
    1. Aisenbrey GA, Catanzarite VA, Nelson C. External cephalic version: predictors of success. Obstet Gynecol. 1999;94:783–6.
    1. Hutton EK, Simioni JC, Thabane L. Predictors of success of external cephalic version and cephalic presentation at birth among 1253 women with non-cephalic presentation using logistic regression and classification tree analyses. Acta Obstet Gynecol Scand. 2017;96:1012–1020.
    1. Kew N, DuPlessis J, La Paglia D, Williams K. Predictors of cephalic vaginal delivery following external cephalic version: an eight-year single-Centre study of 447 cases. Obstet Gynecol Int. 2017;2017:3028398.
    1. Salzer L, Nagar R, Melamed N, Wiznitzer A, Peled Y, Yogev Y. Predictors of successful external cephalic version and assessment of success for vaginal delivery. J Matern Fetal Neonatal Med. 2015;28:49–54.
    1. Buhimschi CS, Buhimschi IA, Wehrum MJ, et al. Ultrasonographic evaluation of myometrial thickness and prediction of a successful external cephalic version. Obstet Gynecol. 2011;118:913–920.
    1. De La Version Par Manoeuvres Externes by Justus Heinrich Wigand (translated in french by François-Joseph Herrgott).
    1. Velzel J, de Hundt M, Mulder FM, et al. Prediction models for successful external cephalic version: a systematic review. Eur J Obstet Gynecol Reprod Biol. 2015;195:160–167.
    1. De Hundt M, Velzel J, de Groot CJ, Mol BW, Kok M. Mode of delivery after successful external cephalic version: a systematic review and meta-analysis. Obstet Gynecol. 2014;123(6):1327–1334.
    1. Boujenah J, Fleury C, Bonneau C, Pharisien I, Tigaizin A, Carbillon L. Successful external cephalic version is an independent factor for caesarean section during trial of labor - a matched controlled study. J Gynecol Obstet Hum Reprod. 2017;46:737–42.
    1. De Hundt M, Vlemmix F, Bais JM, de Groot CJ, Mol BW, Kok M. Risk factors for cesarean section and instrumental vaginal delivery after successful external cephalic version. J Matern Fetal Neonatal Med. 2016;29:2005–2007.
    1. Balayla J, Dahdouh EM, Villeneuve S, Boucher M, Gauthier RJ, Audibert F. Obstetrical and neonatal outcomes following unsuccessful external cephalic version: a stratified analysis amongst failures, successes, and controls. J Matern Fetal Neonatal Med. 2015;28:605–610.
    1. Burgos J, Rodríguez L, Cobos P, et al. Management of breech presentation at term: a retrospective cohort study of 10 years of experience. J Perinatol. 2015;35:803–808.
    1. Coppola C, Mottet N, Mariet AS, et al. Impact of the external cephalic version on the obstetrical prognosis in a team with a high success rate of vaginal delivery in breech presentation. J Gynecol Obstet Biol Reprod (Paris) 2016;45:859–865.
    1. Wastlund, et al. Screening for breech presentation using universal late-pregnancy ultrasonography: A prospective cohort study and cost effectiveness analysis. PLoS Med. 2019;16(4):e1002778.

Source: PubMed

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