Breech presentation induction compared to cephalic presentation: effectiveness and characteristics

Published:January 25, 2023DOI:


      • To our knowledge, no recent trial has compared the characteristics of cases involving induction of breech with those of cephalic presentation. Our study included a larger cohort of breech babies than often found in the literature, and it was conducted at a level III maternity hospital, where vaginal delivery of breech babies is governed by well-defined protocols and performed by trained obstetric teams (
        • Michel S.
        • Drain A.
        • Closset E.
        • Deruelle P.
        • Ego A.
        • Subtil D.
        Evaluation of a decision protocol for type of delivery of infants in breech presentation at term.
        ). The single-center nature of our study limits the bias linked to the center effect but reduces the ability to extrapolate our results.
      • The matching of patients beforehand enabled us to avoid possible confusion bias between the two groups studied. The data were collected similarly for both groups, although the retrospective design did not allow us to match parity perfectly because we had to correct parity errors encountered after checking the files. Matching also created some selection bias in the cephalic population because it represented only a portion, but not all, of the cephalic induced births during the data collection period. Although long, the inclusion period, that started in 2014 required us to remain vigilant because the induction and labor protocols were constantly updated at our center.
      • Limitations to this study are inherent to the non-randomized design. The present findings are derived from observational analyses, which are subject to well-known limitations. Since no formal study sample size was calculated, we could not exclude that we lacked adequate statistical power. In a posterior power calculation, we calculated the smallest significant odds ratio that our study allowed us to detect for both primary outcomes with an 80% power and by using the observed outcome rates in cephalic group (considered as control group). For vaginal delivery we could detect an OR of 2.50 (or 0.48 in cases of negative effect of breech vs. cephalic group) by considering an outcome rate of 74.3%, in cephalic group and for transition to active phase we could detect an OR of 2.96 (or 0.46 in case of negative effect) by considering an outcome rate of 80.7%, in cephalic group, which correspond to large effect sizes.
      • Similarly, our small number of triggered breech births did not allow us to perform multivariate analysis to identify the factors that predict successful induction.
      • Conclusion.
      • Breech presentation, especially when associated with induction, remains an obstetric problem, and our study has provided some additional data about its management. Despite some differences with the cephalic presentation, induction of labor in breech presentation seems to be as effective and as safe as cephalic presentation at the maternal level. Induce a breech fetus can therefore be considered as an option provided that patients eligible for vaginal delivery are selected.



      The objective of our study was to compare the effectiveness of induction in cephalic presentations to that of breech presentations as well as the characteristics of the latter and the maternal-fetal morbidity and mortality.

      Material and methods

      This was a single-center retrospective study carried out at the Lille University Hospital in the Jeanne de Flandre Maternity Hospital including all patients with a breech fetus for whom an induction was indicated beyond 37 weeks of gestation between January 2014 and December 2020. A matching was performed to include 2 cephalic presentations for one breech presentation. The primary outcome was successful induction defined by two things: passage into the active phase (cervical dilatation > 5 cm) and vaginal delivery.


      101 inductions of breech presentations were included and matched to 202 cephalic presentations. After adjustment by BISHOP score, there was no significant difference in the caesarean section rate between the two groups (25.7% in cephalic vs 33.7% in breech, OR 0.67 [CI95% 0.38-1.18]) or in the rate of transition to active phase (80.7% in cephalic vs 82.2% in breech, OR 1.26 [CI95% 0.65-2.44]). Post-partum blood loss was not significantly different between the two groups (14.4% in cephalic vs 12.9% in breech, OR 1.22 [CI95% 0.57-2.57]). Moderate neonatal acidosis was more frequent in the breech group (6,4% in cephalic vs. 15,8% in breech, OR 3.04 [CI95% 1.38-6.71]).


      Induction of breech births beyond 37 weeks of gestation appeared to be as effective as induction of cephalic presentations. There was no difference in the rate of caesarean section and transition to active labor. Maternal morbidity was not increased.


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