Vaginal Breech Delivery Outcomes

A prospective cohort study was performed on the cohort of women presenting with breech at term (>37 weeks) at the Goethe University Hospital Frankfurt, Germany from January 2004 to December of 2016. The ethics committee of the Goethe University Hospital Frankfurt approved of the study protocol (Reference number 420/11). The requirement for patients informed consent was waived by the committee as all data was obtained within the hospitals standard care of patients intending a vaginal breech delivery. Patients received treatment as usual and only clinically relevant and required data was documented. Data was extracted from treatment files and anonymized by treating obstetricians who are part of the ethics committee approved study team. The ‘Perinatalerhebung Hessen’, a state database was used to obtain the data. Missing data, the mothers’ patient history as well as diagnoses and outcome parameters of neonates who were admitted to the neonatal intensive care unit (NICU) were gathered using the hospitals patient management system. All data was acquired and set into a table for analysis within this study after the patients were discharged. Of 1743 cases with a breech presentation at term 1054 expecting women intended a vaginal birth approach and did not meet exclusion criteria. Exclusion criteria were planned cesarean delivery (due to the reasons maternal wish, intrauterine growth restriction, malformations of the uterus, inability to perform spontaneous birth not related to the fetal position), insulin-treated diabetes, infant’s birth weight of over 4.49 kg or less than 2.5 kg. (Fig 1)
Women with breech presentation register for birth and delivery planning at the outpatient clinic at 34 to 36 weeks of gestation Vaginal delivery approach from breech position was offered in case of a successful previous vaginal birth or an obstetrical conjugate above 12 cm (measured by MRI) and an estimated birth weight of 2.5 kg or more of a proportional grown fetus. Weight of the fetus of ≥3.8kg, previous cesarean delivery or head flexion did not lead to exclusion.
Louwen et al. showed a superior maternal and fetal outcome from birth position on knees and arms or in upright position [5 (link)] The preferred birth position in all vaginal deliveries was on knees and arms or in upright position. In some cases, dorsal position was used to perform manual assisted delivery. In this study all birth positions were included.