Routine maneuvers in eutocic breech vaginal delivery at term: A prospective cohort study

Area of Science:

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

Background:

• Term breech vaginal delivery is associated with potential risks to both mother and neonate.
• The role of routine maneuvers in mitigating or exacerbating these risks remains a subject of clinical inquiry.
• Understanding outcomes related to specific delivery techniques is crucial for optimizing obstetric practice.

Purpose of the Study:

• To evaluate neonatal and maternal outcomes in term breech vaginal deliveries.
• To compare outcomes between deliveries involving routine maneuvers versus those without.

Main Methods:

• Secondary analysis of the multicenter PREMODA prospective observational study.
• Inclusion of women with vaginal breech delivery, excluding those with maneuvers for dystocia.
• Comparison of maternal and neonatal outcomes between groups with and without routine maneuvers, using multivariate logistic regression for adjusted analysis.

Main Results:

• A total of 1163 women were included (537 in routine maneuvers group, 626 in no maneuvers group).
• Adverse perinatal outcome rates were comparable (4.5% vs 5.0%, P=0.65), with no neonatal deaths.
• Third-degree perineal tears and postpartum hemorrhage rates were similar; primiparity and birth weight <2500g were associated with adverse outcomes.

Conclusions:

• Routine maneuvers in term breech vaginal delivery are not associated with increased neonatal morbidity.
• The study identified primiparity and low birth weight as factors linked to adverse perinatal outcomes.