Port Royal Maternity Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
DHU Risks in Pregnancy, Paris, France.
Acta Obstet Gynecol Scand. 2019 Jul;98(7):885-893. doi: 10.1111/aogs.13557. Epub 2019 Feb 24.
Whereas spontaneous onset of labor and vaginal delivery for breech presentation is considered to be a safe and effective option in selected cases, the safety of induction of labor is not established yet. The objectives of this study were to describe the outcomes of pregnancy in women induced with a fetus in breech presentation and compare the outcomes with those undergoing planned cesarean delivery.
We performed a secondary analysis of the observational prospective multicenter PREMODA study, including all singleton breech deliveries after 37 weeks in 174 centers in France and Belgium. We excluded women with spontaneous onset of labor, scarred uterus or intrauterine fetal death. Our study population consisted of women with either induction of labor or planned cesarean delivery. The primary outcome was the composite criteria of neonatal mortality and serious morbidity used in the Term Breech Trial and in the PREMODA prospective cohort.
Our study population consisted of 4138 women, 218 with induction of labor and 3920 with planned cesarean. Two-thirds (67.4%) of the women in the induction of labor group delivered vaginally. There was no significant difference between the groups for the primary outcome (48 [1.2%] in the planned cesarean group vs 3 [1.4%] in the induction of labor group, P = 0.75). Moreover, none of the criteria of the composite primary outcome was significantly more frequent in the induction of labor group.
Induction of labor for breech presentation does not seem to increase neonatal mortality or severe neonatal morbidity compared with planned cesarean delivery.
虽然自发性分娩和阴道分娩对于臀位是一种安全有效的选择，但是诱导分娩的安全性尚未确定。本研究的目的是描述经阴道分娩和计划性剖宫产的臀位妊娠结局，并对其进行比较。
我们对法国和比利时 174 个中心进行的前瞻性多中心 PREMODA 观察性研究进行了二次分析，包括所有 37 周后臀位的单胎妊娠。我们排除了自发性临产、有剖宫产史或宫内胎儿死亡的妇女。我们的研究人群包括接受引产或计划性剖宫产的妇女。主要结局是胎龄足月臀位试验和 PREMODA 前瞻性队列中使用的新生儿死亡率和严重并发症的综合标准。
我们的研究人群包括 4138 名妇女，218 名接受引产，3920 名接受计划性剖宫产。引产组中三分之二（67.4%）的妇女经阴道分娩。两组在主要结局（计划性剖宫产组 48 例[1.2%] vs 引产组 3 例[1.4%]，P=0.75）方面无显著差异。此外，引产组复合主要结局的任何标准均无显著增加。
与计划性剖宫产相比，臀位诱导分娩似乎不会增加新生儿死亡率或严重新生儿并发症。
