The term breech presentation: Neonatal results and obstetric practices in France.
OBJECTIVE
Compare neonatal complications according to the planned mode of delivery and according to whether the women gave birth at a maternity unit that applied "consensus" guidelines.


METHODS
The study used the database of the AUDIPOG Sentinel Network (n=71,919 pregnancies between 1994 and 2000). The principal outcome was a composite variable that included neonatal morbidity and mortality. A survey of obstetric practices was sent to 175 maternity units belonging to the network. Consensus guidelines were defined from the survey responses and taken into account in the database analysis.


RESULTS
Neonatal complications did not differ between the group of women with term babies in breech presentation for whom vaginal delivery was planned and those for whom an elective caesarean was planned (adjusted OR=1.33; 95% CI: 0.63-2.80). The survey allowed us to define a set of six criteria for deciding on mode of delivery; it established a consensus, followed by 42% of the maternity units in the study. The rate of neonatal complications among the women with planned vaginal delivery was lower for those giving birth in units that applied the consensus guidelines than among those in the other units: adjusted OR=0.27 (95% CI: 0.09-0.85).


CONCLUSIONS
The risk of neonatal morbidity according to planned mode of delivery for term breech babies was lower for those giving birth in units that applied the consensus guidelines than among those in the other units.
Vendittelli
F
F
Fédération de Gynécologie-Obstétrique, CHU de Clermont-Ferrand, France; AUDIPOG, Centre de Recherche INSERM, Lyon, France; INSERM U369, Groupe "Epidémiologie de la Croissance et du Développement", Lyon, France. fvendittelli@chu-clermontferrand.fr
Pons
J C
JC
Lemery
D
D
Mamelle
N
N
D000328:Adult; D001720:Birth Injuries / Q000209:etiology*; D001946:Breech Presentation / Q000401:mortality / Q000628:therapy; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000379:methods / Q000592:standards; D005260:Female; D005313:Fetal Death / Q000453:epidemiology; D005602:France / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome