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Introduction: Vaginal delivery out of a breech presentation in pregnancies at term are being re-implemented into clinical practice. Still, recommendations regarding exclusion criteria leading to caesarean sections are based on expert opinions, not on evidence-based guidelines. The difference in perinatal outcome and course of delivery in births with babies in frank breech position and babies in incomplete or complete breech presentation never has been investigated in a large patient cohort., Objective: To compare perinatal outcome of vaginally intended breech deliveries between births out of frank breech position and incomplete/complete breech presentation., Design: Prospective cohort study., Sample: 884 women at term with a singleton in frank breech presentation (FB) and 284 women with incomplete or complete breech presentation (CB) intending vaginal birth between January 2004 and December 2018., Methods: Maternal and fetal outcome was compared between groups using Pearson's Chi Square test. Birth duration parameters were analysed using logistic regression., Results: There were no differences in cesarean section rates (FB: 25.1%, CB 22.2%, p = 0.317). Short-term fetal morbidity did not differ between groups (FB: 2.5%, CB: 2.8%, p = 0.761). In vaginal deliveries the necessity to perform manual assistance was significantly more frequent in deliveries of infants in CB (FB: 39.9%, CB: 51.6%, p = 0.0013). Cord loops (FB: 10.1%, CB: 18.0%, p = 0.0004) and cesarean sections necessary because of cord prolapses (FB: 1.4%, CB 8.1%, p = 0.005) were significantly more often in deliveries with babies in CB., Conclusion: This study provides evidence, that perinatal morbidity is not associated with the fetal leg posture in vaginally intended breech deliveries. The higher risk for the need of manual assistance during vaginal birth in deliveries of babies out of complete or incomplete breech presentation suggests that obstetrical departments re-implementing the vaginal breech in their repertoire might start with births of babies out of frank breech presentation., Competing Interests: The authors have declared that no competing interests exist.

Data from the literature on induction of labour in breech presentation are rare and no conclusions can be drawn for this procedure., Objectives: To evaluate obstetrical and neonatal prognosis following induced labour in breech deliveries at term (37 to 42 weeks of gestation)., Methods: We conducted a single-centre retrospective case-control study in a level IIB maternity unit from 1st January 2012 to 31st December 2015. The inclusion criteria were a singleton pregnancy and a breech presentation., Results: A total of 235 patients were included, 178 in the spontaneous labour group (group A), 57 in the induced labour group (whatever the procedure used: oxytocin or prostaglandin) (group B). There was no significant difference concerning the vaginal delivery rate between group A and group B (88.2% versus 91.2%). Both groups were also similar for transfers to neonatal units (10.7% versus 15.8%), pH<7.0 (1.1% versus 1.8%) and 5-minute Apgar<4 (1.1% versus 1.7%). There were no neonatal deaths or transfers to neonatal intensive care units., Conclusion: Induced labour in breech presentation is feasible with a vaginal delivery rate similar to that in spontaneous labour and the same neonatal outcomes. This therapeutic option must be considered in trained obstetrical teams when vaginal delivery in breech presentations is not contraindicated., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Objective: Investigate the rate of internal podalic version followed by breech extraction for a second non-vertex twin with the first delivered vaginally, and compare neonatal outcome with emergency cesarean section., Design: Cohort study., Setting: National Danish Registers., Population: Twin pregnancies (1997-2012) with gestational age ≥34 weeks; first twin delivered vaginally, second by internal podalic version and breech extraction or cesarean section., Methods: Data were collected from the Danish National Patient Register and the Danish National Birth Register., Main Outcome Measures: Rates of delivery mode, 5-min Apgar score, asphyxia, umbilical cord pH, admission to neonatal intensive care unit, treatment by mechanical ventilation, and experience level of obstetricians performing internal podalic version., Results: 457 births were available for analysis: 39 cases of internal podalic version and breech extraction and 418 cesarean section cases for second twin. Compared with the cesarean section group, the internal podalic version group had lower rates of asphyxia. Apgar scores and umbilical cord pH levels were not significantly different, although with a tendency to be higher in the internal version than the cesarean section group, however, fewer cases needed mechanical ventilation. Thirty internal versions and breech extractions were performed by obstetricians with >5 years clinical experience and three by trainees., Conclusion: Cesarean sections for a second twin seem to have been frequent during the last 15 years while internal podalic version is a vanishing procedure. A slight tendency for better neonatal outcome was found in the internal podalic version and extraction group than cesarean section., (© 2014 Nordic Federation of Societies of Obstetrics and Gynecology.)