Pronostic obstétrical et néonatal d’une présentation podalique de mauvaise réputation : le siège complet

OBJECTIVES A nonfrank breech is generally believed to be associated with abnormal labor and risk of cord prolapse. Owing to these risks, many authors consider such a presentation as a positive indication for cesarean section. The purpose of this study was to estimate the delivery characteristics of nonfrank breech with a gestational age over 37 weeks and particularities of this presentation. PATIENTS AND METHODS This retrospective study included all deliveries with a nonfrank breech presentation and a gestational age over 37 weeks over a sixteen years period in our maternity ward. A descriptive analysis of maternal, fetal and obstetrical elements was carried out. RESULTS 198 deliveries were indexed with 54% vaginal birth, regularly observed throughout the study period. Thirty percent delivered by prelabor planned cesarean section and 16% by cesarean section during labor. When a vaginal birth trial was allowed, at last 77.4% delivered by this route. Average labor time in the vaginal birth group was only 4.5 hours. Eleven cord prolapses were found (5.6%) of which more than half delivered by vaginal birth without fetal complications. Perinatal outcomes were satisfactory for the whole population, without differences between cesarean section and vaginal birth. DISCUSSION Cord prolapse is a risk of nonfrank breech presentation but abnormal labor is not more frequent than with frank breech presentations if labor is managed rigorously. More than 75% patients of the vaginal birth trial group delivered by vaginal birth with perinatal outcomes as good as the cesarean section group. Unlike traditional reports, in our study a nonfrank breech was not an unfavorable factor for vaginal birth after strict selection of vaginal birth trial candidates.