Breech Presentation: CNGOF Guidelines for Clinical Practice - Short Text

• Published in: Gynécologie, obstétrique, fertilité & sénologie Vol. 48; no. 1; pp. 63 - 69
• Main Authors: Sentilhes, L, Schmitz, T, Azria, E, Gallot, D, Ducarme, G, Korb, D, Mattuizzi, A, Parant, O, Sananès, N, Baumann, S, Rozenberg, P, Senat, M-V, Verspyck, É
• Format: Journal Article
• Language: French
• Published: France 01-01-2020
• Subjects: Breech presentation; Maternal and neonatal morbidity; Siège; Planned cesarean delivery; Morbidité maternelle et néonatale; Planned vaginal delivery; Tentative de voie basse; Césarienne programmée; Version par manœuvre externe; External cephalic version
• ISSN: 2468-7189
• DOI: 10.1016/j.gofs.2019.10.025

To determine the optimal management of singleton breech presentation.
The PubMed database, the Cochrane Library and the recommendations from the French and foreign obstetrical societies or colleges have been consulted.
In France, 5% of women have breech deliveries (Level of Evidence [LE3]). One third of them have a planned vaginal delivery (LE3) of whom 70% deliver vaginally (LE3). External cephalic version (ECV) is associated with a reduced rate of breech presentation at birth (LE2), and with a lower rate of cesarean section (LE3) without increases in severe maternal (LE3) and perinatal morbidity (LE3). It is therefore recommended to inform women with a breech presentation at term that ECV could be attempted from 36 weeks of gestation (Professional consensus). In case of breech presentation, planned vaginal compared with planned cesarean delivery might be associated with an increased risk of composite perinatal mortality or serious neonatal morbidity (LE2). No difference has been found between planned vaginal and planned cesarean delivery for neurodevelopmental outcomes at two years (LE2), cognitive and psychomotor outcomes between 5 and 8 years (LE3), and adult intellectual performances (LE4). Short and long term maternal complications appear similar in case of planned vaginal compared with planned cesarean delivery in the absence of subsequent pregnancies. A previous cesarean delivery results for subsequent pregnancies in higher risks of uterine rupture, placenta accreta spectrum and hysterectomy (LE2). It is recommended to offer women who wish a planned vaginal delivery a pelvimetry at term (Grade C) and to check the absence of hyperextension of the fetal head by ultrasonography (Professional consensus) to plan their mode of delivery. Complete breech presentation, previous cesarean, nulliparity, term prelabor rupture of membranes do not contraindicate planned vaginal delivery (Professionnal consensus). Term breech presentation is not a contraindication to labor induction when the criteria for acceptance of vaginal delivery are met (Grade C).
In case of breech presentation at term, the risks of severe morbidity for the child and the mother are low after both planned vaginal and planned cesarean delivery. For the French College of Obstetricians and Gynecologists (CNGOF), planned vaginal delivery is a reasonable option in most cases (Professional consensus). The choice of the planned route of delivery should be shared by the woman and her caregiver, respecting the right to woman's autonomy.