Neonatal morbidity and mortality for preterm in breech presentation regarding the onset mode of labor

• Published in: Archives of gynecology and obstetrics Vol. 307; no. 3; pp. 729 - 738
• Main Authors: Claire, Guerini, Diane, Korb, Olivier, Sibony
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.03.2023; Springer Nature B.V
• Subjects: Apgar score; Breech Presentation; Cesarean Section; Delivery, Obstetric; Endocrinology; Female; Gynecology; Human Genetics; Humans; Induced labor; Infant, Newborn; Maternal-Fetal Medicine; Medicine; Medicine & Public Health; Morbidity; Mortality; Obstetrics/Perinatology/Midwifery; Pregnancy; Pregnancy Outcome; Retrospective Studies; Spontaneous labor; Breech; Neonatal morbidity; Induction of labor; Cesarean section; Preterm
• ISSN: 1432-0711; 0932-0067; 1432-0711
• DOI: 10.1007/s00404-022-06526-z

Purpose To assess severe neonatal morbidity and mortality in induced labor in preterm breech deliveries, compared to spontaneous labor. Methods This is a retrospective study conducted in a tertiary university center in France. Women with single live breech pregnancy between 28 + 0 and 36 + 6 weeks gestation were included. We excluded situations with medical contraindication to vaginal delivery and fetal malformations. We compared women with an unfavorable cervix, who had an indication for deliver and could receive cervical ripening to induce labor, to women in spontaneous labor. The primary outcome was a composite criterion of severe neonatal morbidity and mortality including perinatal death, traumatic event during delivery, Apgar score at 5-min < 4, moderate or severe encephalopathy, seizures within the first 24 h, Intra-Ventricular Hemorrhage grade 3 or 4, necrotizing enterocolitis grade 2 or 3. Results We included 212 patients: 64 in the induced labor group and 136 in the spontaneous labor group. In the induced labor group, 45.3% of patients delivered vaginally, and 86% in spontaneous labor group. The neonatal morbidity and mortality rate were similar in both groups: 4.7% in the induced labor group, and 5.2% in the spontaneous labor group, p =  0.889, aOR = 1.5 (0.28–8.28). Conclusion Nearly half of the patient who received induction of labor delivered vaginally. The onset mode of labor does not appear to have an effect on severe neonatal morbidity and mortality in preterm breech fetuses. Induction of labor could be an option for patients in this setting.