Induction of labor in breech presentations ‐ a retrospective cohort study

Abstract

Introduction: There is limited evidence on the safety and outcome of induction of breech labor.In this study, we aimed to compare the outcomes of spontaneous and induced breech deliveries and to describe variations in induction rates. Material and methods:This was a retrospective cohort study comprising 1054 singleton live fetuses in breech presentation at Trondheim University Hospital from 2012 to 2019. The main outcome was intrapartum cesarean section, and secondary outcomes were postpartum hemorrhage, anal sphincter ruptures, Apgar scores, pH in the umbilical artery and metabolic acidosis. All data were obtained from the hospital birth journal.Results: Induction of labor was performed in 127/606 (21.0%) of women with planned vaginal birth. The frequency of intrapartum cesarean section was 48.0% for induced labor vs 45.7% for spontaneous labor (p=0.64). We found no differences in the frequency of postpartum hemorrhage or anal sphincter ruptures between induced and spontaneous births. The median pH in the umbilical artery was significantly lower in neonates with induced labor compared with neonates with spontaneous labor (7.22 vs 7.25; p=0.02). The frequency of pH <7.05 was 7.0% for induced labor vs 2.9% (p= 0.05) for spontaneous labor, but the frequency of pH <7.0 was not significantly different: 2.6% vs 0.8% (p=0.14), respectively. Three neonates with planned vaginal birth had metabolic acidosis: two with spontaneous labors and one with induced labor. Three fetuses with planned vaginal birth died during labor: two with spontaneous onset of labor and one with induced labor. All three were extremely preterm: two were delivered in week 23 and one in week 25. We did not observe any significant trend in induction rates in either parous or in nulliparous women. Conclusions:The induction rates were stable during the study period. We did not observe any significant difference in intrapartum cesarean section rates, in the frequency of pH <7.0 in the umbilical artery, or in the frequency of metabolic acidosis when comparing induced and spontaneous breech deliveries.

Neonatal Morbidity after Cervical Ripening with a Singleton Fetus in a Breech Presentation at Term

“…The CRB was the most frequently used device for cervical ripening (20/27, 74.1%). This rate was higher than in a large retrospective cohort study of women with singleton live fetuses in a breech presentation who required cervical ripening (55.1%) [ 16 ]. Few data are reported for a comparison of the different methods of cervical ripening among women with a breech presentation at term [ 17 , 18 ], and the use of CRBs and dinoprostone seemed to be similar for neonatal morbidity.…”

The usefulness of ultrasound before induction of labor

“…7 However the issue of IOL in breech presentation has been the subject of some controversies. [18][19][20][21] The mainstay for fetal presentation identification is clinical examination. Nevertheless, in some cases there might be some difficulty or uncertainty to the accurate determination of the fetal presentation, as in morbid obesity or excessive abdominal wall scarring.…”

Breech and induction. Time for evidence‐based informed consent

“…Women should be informed about the three to four times increased risk of low Apgar score associated with vaginal breech delivery in general, and increased risk of low pH, and possibly increased risk of cesarean section and neonatal admission in particular, for induction. Jeppe B. Schroll 1,2…”