Neonatal Morbidity after Cervical Ripening with a Singleton Fetus in a Breech Presentation at Term

Area of Science:

• Obstetrics and Gynecology
• Perinatal Medicine
• Maternal-Fetal Medicine

Background:

• Vaginal delivery for breech presentation is common in France, but labor induction remains infrequent.
• Limited data exists on the safety and efficacy of cervical ripening for term breech presentations.

Purpose of the Study:

• To compare severe maternal and neonatal morbidity based on planned mode of labor in term breech presentations.
• Specifically, to evaluate cervical ripening against spontaneous labor, induction with a favorable cervix, and elective cesarean delivery.

Main Methods:

• Retrospective study of 362 women with term singleton breech presentation.
• Comparison of severe maternal and neonatal morbidity across different labor management strategies.
• Multivariable logistic regression analysis to assess the association between cervical ripening and morbidity.

Main Results:

• Severe neonatal morbidity was 3.0% and significantly higher with induction of labor compared to elective cesarean delivery (p=0.02).
• Severe maternal morbidity rates were similar across all planned modes of labor.
• Cervical ripening was not significantly associated with increased composite severe neonatal (aOR 2.80) or maternal morbidity (aOR 1.29).

Conclusions:

• Cervical ripening can be offered to appropriately selected term breech presentation candidates.
• This approach does not appear to increase the incidence of severe maternal or neonatal morbidity.