[Breech presentation and vaginal delivery: evolution of acceptability by obstetricians and patients].
OBJECTIVE
To investigate the influence of obstetrician and patient respectively on mode of delivery in case of breech presentation at term.


METHODS
This retrospective study included all women with a singleton pregnancy in a breech presentation delivered at term in a tertiary care maternity unit from January 1998 to December 2004. Mode of delivery was suggested by a score based on maternal age, parity, obstetrical past history, radiopelvimetry and cephalopelvic confrontation. The obstetrician was free to follow or not the score indication and patient's informed consent was required concerning the mode of delivery. Our main outcome measurements were mode of delivery and neonatal parameters.


RESULTS
Two hundred cases were identified. Elective cesarean section increased progressively (from 52% in 1998 to 80% in 2004 [P=0,002]). Neonatal status and proportion of score in favour of vaginal birth remained stable during the study period. The rise in cesarean section rate was mainly due to patient's request (P=0,001) whereas the trend of obstetrician in favour of cesarean did not reach significance (P=0,3).


CONCLUSIONS
The rise of elective cesarean section for term breech delivery in a maternity unit using a predefinite score is mainly induced by patient's request. This evolution has no effect on neonatal status.
Lagrange
E
E
Pôle gynécologie-obstétrique-reproduction humaine, CHU de Clermont-Ferrand, Hôtel-Dieu, boulevard Léon-Malfreyt, 63003 Clermont-Ferrand, France.
Ab der Halden
M
M
Ughetto
S
S
Boda
C
C
Accoceberry
M
M
Neyrat
C
C
Houlle
C
C
Vendittelli
F
F
Laurichesse-Delmas
H
H
Jacquetin
B
B
Lémery
D
D
Gallot
D
D
D001946:Breech Presentation / Q000523:psychology; D036861:Delivery, Obstetric / Q000523:psychology; D005260:Female; D006801:Humans; D010342:Patient Acceptance of Health Care; D010817:Physician-Patient Relations; D011247:Pregnancy