[Breech Presentation: CNGOF Guidelines for Clinical Practice - Labour and Induction]

Abstract

Objectives: To issue guidelines on management of labour induction and breech vaginal delivery.

Materials and methods: Bibliographic search restricted to French and English languages using Medline database®, Cochrane Library and international guidelines of medical societies.

Results: Breech delivery must take place in a maternity ward, in the presence of an obstetrician and gynaecologist and with the immediate availability of an anesthesiologist and a pediatrician during active second stage (Professional consensus). Term breech is not a contraindication to labour induction when the criteria for acceptance of vaginal delivery are met (Grade C). In this case, oxytocin or prostaglandins can be used (Grade C). Epidural analgesia with low concentrations of local anesthetics should be encouraged in case of vaginal delivery attempt (Professional consensus). It is recommended to use continuous monitoring of the CTG (Professional consensus). The use of second-line fetal monitoring is not recommended (Professional consensus). The administration of oxytocin is possible for labour augmentation (Professional consensus). It is better to start the expulsive efforts when the presentation is engaged as low as possible in the pelvic excavation (Professional consensus). Breech presentation is not an indication of episiotomy (Professional consensus). Due to insufficient data, it was not possible to make recommendations on specificities of preterm breech delivery.

Conclusion: In case of planned vaginal delivery, labour induction is possible for term breech fetuses, even with unfarable cervix. Guidelines for labour and vaginal delivery management have a low level of evidence.

Keywords: Accouchement vaginal; Breech; Dystocia; Dystocie; Déclenchement du travail; Labour; Labour induction; Manœuvres obstétricales; Obstetrics maneuvers; Présentation du siège; Travail; Vaginal delivery.