[Evaluation of decisional elements of vaginal delivery in case of breech presentation in 19 university hospitals in France].
BACKGROUND
Recently, a Belgo-French study led by PREMODA group showed that there was no significant difference between caesarean and vaginal delivery for neonatal outcome.


OBJECTIVE
To study protocols and rate of vaginal delivery of single breech in 2006 in the 30 French teaching hospitals that participated to the PREMODA study.


METHODS
Postal survey.


RESULTS
Nineteen university hospitals answered (63%). Eighteen used a written protocol and three of them underwent systematic prophylactic caesarean section for breech presentation. Among 15 others, the decision criteria for the way of delivery included pelvimetry, absence of primary cephalic deflexion and foetal measurements. Some centres required additional restrictions. The rates of vaginal delivery varied from 1.7 to 49.7% depending on the centre with very different policies concerning decisional elements. Protocols with restrictions less than three were associated with higher percentages of vaginal delivery (28.9% vs. 21.6%, p<0.001).


CONCLUSIONS
Most of teaching centres use a written protocol for breech delivery. Huge variations exist between vaginal delivery rates which seems partially linked to the number of restrictions of the protocol. However, criteria used to accept vaginal delivery in breech presentation are variable between centres and do not lie on objective findings.
Michel
S
S
Pôle d'obstétrique, hôpital Jeanne-de-Flandre, université Lille II, 2, avenue Oscar-Lambret, 59037 Lille cedex, France. sm.net@voila.fr
Drain
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A
Closset
E
E
Deruelle
P
P
Subtil
D
D
D001946:Breech Presentation; D002585:Cesarean Section / Q000706:statistics & numerical data; D003657:Decision Making; D036861:Delivery, Obstetric / Q000379:methods; D005260:Female; D005602:France; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D011256:Pregnancy Outcome; D011795:Surveys and Questionnaires