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Cervical maturation in breech presentation: Mechanical versus prostaglandin methods
M Khobzaoui1, L Ghesquiere2, E Drumez3
1CHU Lille, Department of Obstetrics, F-59000, Lille, France.
Summary
Induction methods for term breech presentation, including cervical dilatation balloons and prostaglandins (PGE2), show similar cesarean rates. However, mechanical methods often require additional prostaglandin use, and nulliparity or high BMI increase induction failure risk.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Reproductive Medicine
Background:
- Breech presentation at term occurs in approximately 5% of births.
- Limited research exists on effective induction methods for term breech presentations.
- Vaginal delivery is often considered when the cervix is unfavorable (Bishop score < 6).
Purpose of the Study:
- To compare delivery outcomes after induction using an intracervical dilatation balloon versus prostaglandin (PGE2) for term breech presentation.
- To identify risk factors associated with induction failure in this population.
Main Methods:
- Retrospective single-center study (2000-2020) of women with term breech presentation, unfavorable cervix, and no contraindications to vaginal delivery.
- Induction methods compared: intracervical dilatation balloon vs. prostaglandin (PGE2).
- Primary endpoint: mode of delivery; induction failure defined as cesarean section.
Main Results:
- 176 patients included (96 balloon, 80 prostaglandin).
- Cesarean section rates were similar: 34.4% (balloon) vs. 26.3% (prostaglandin), p=0.24.
- 50% of balloon group required additional prostaglandin maturation; induction failure linked to nulliparity and BMI > 30 kg/m².
Conclusions:
- Mechanical induction (dilatation balloon) and prostaglandin (PGE2) show comparable cesarean rates for term breech presentation.
- Mechanical methods frequently necessitate supplementary prostaglandin use, questioning their standalone efficacy.
- Maternal factors like nulliparity and obesity (BMI > 30 kg/m²) are significant predictors of induction failure, independent of the induction method.
