[Breech presentation: management (304 cases)]

BUT: Try to precise the optimal management in 1997 face a breech presentation.

Between January 1991 and December 1995, 304 cases of breech presentations were listed at the maternity of Pavillon Victor Olivier (Lille). From these 304 breech presentations, all parities blended, the authors have analysed the mode of delivery of these patients, distinguishing the para one from the multiparous women and the preterm babies from the other babies. From this study and a review of the literature, were discussed the criterions which can help the practitioner to determine the mode of delivery of these fetus.

The results show a cesarean section (cs) rate of 51% (41% of first intention cs and 10% of second intention cs were realized only for primiparity + breech presentation and 67% of the para one women benefited from a first intention cs 8.72% of vaginal deliveries were complicated, and 5 fetal injuries were noted without sequel. On 296 live new-borns, only 2 cases of fetal death were perhaps due to the vaginal delivery. Fetal mortality is principally reliable at the prematurity and the congenital malformations, but finally, not due to mode of delivery.

The difficulty is to determine rigorous criterions of selection to authorize a vaginal delivery without spoil the fetal pronostic. The major criterions are a perfect radiopelvimetry, an estimated fetal weight < 3800 g for the para one women and < 4300 g for the multiparous woman, a well flexed fetal head, favorable obstetric conditions ond the absence of maternal or fetal complications. The primiparity is not an indication of systematic cesariean section.