Discourse on the Mother's Decision Regarding the Mode of Delivery in Cases of Breech Presentation
For patients and families
In plain language
An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.
- What is being studied
- The protocol lists: To complete a questionnaire.
- Who it may be relevant to
- Registry conditions: Breech Presentation. Basic parameters: from 18 years · All.
- What needs checking
- Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
- Where it takes place
- France
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
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Official title
Impact of the Practitioner's Discourse on the Mother's Decision Regarding the Mode of Delivery in Cases of Breech Presentation
Overview
Breech presentation is a common occurrence in routine practice, occurring in 3-4% of all term pregnancies. Despite its frequency, breech presentation at term remains a subject of considerable controversy within the medical community. This results in differing management approaches depending on the country, the center, and the practitioner. Indeed, from a pathophysiological perspective, during a breech delivery, the fetal head is the last segment to descend into the maternal pelvis. This is the largest fetal segment in terms of volume. Furthermore, the fetal head cannot accommodate itself to the maternal pelvis through plastic deformation. This presentation can therefore lead to specific complications that may be life-threatening for the unborn child. Despite its frequency, breech presentation at term remains a subject of considerable controversy within the medical community regarding the management of labor. In the 2000s, a randomized trial called the TERM BREECH TRIAL found a neonatal benefit of planned cesarean section compared to vaginal delivery of a breech fetus (prevention of perinatal death in 1% of cases). This resulted in a significant increase in the rate of planned cesarean sections for breech presentation worldwide. However, numerous more recent studies (notably PREMODA in France) have highlighted the many biases of the Term Breech Trial, and various literature reviews (including the 2015 Cochrane review) have demonstrated lower perinatal morbidity than that found by Hannah's team. In 2020, the CNGOF (National College of Gynecologists and Obstetricians of France) published new recommendations on the management of breech presentations at the end of pregnancy, proposing vaginal delivery as a possible alternative to a planned cesarean section, provided that the patient receives clear and honest information (benefits and risks of each delivery method). The choice of delivery method must be made in consultation with the patient after a dedicated consultation. Since these recommendations were published, management practices still vary between hospitals despite fairly precise guidelines.
Interventions
- Other To complete a questionnaire
Doctor and Adult woman agreeing to complete the self-administered questionnaire anonymously.
Primary outcome measures
- Overall satisfaction of women who gave birth to a breech fetus regarding their medical care [Time frame: Up to 12 months]
Eligibility criteria
Inclusion criteria
Regarding practitioners:
- Doctor with a medical degree (Junior Doctor, Clinical Assistant, Hospital Practitioner, University Professor of Obstetrics), with a primary focus on Obstetrics
- Practicing in a University Hospital in the Grand Est region (Besançon, Reims, Strasbourg, Nancy)
- Agreeing to complete the self-administered questionnaire anonymously.
Regarding patients:
- Patient of legal age (≥ 18 years)
- Having given birth in 2024 in a university hospital in the Grand-Est region (Besançon, Reims, Strasbourg, Nancy)
- Delivery of a breech fetus > 37 weeks of gestation
- Agreeing to answer the self-administered questionnaire anonymously.
Exclusion criteria
Regarding practitioners:
Other primary activity than obstetrics
Regarding patients:
- Minor patient at the time of delivery
- Patient who had a cesarean section due to a uterine scar and maternal desire.
- Patients with a history of uterine scarring or the presence of obstruction previa were also excluded due to the impossibility of authorizing vaginal delivery, regardless of fetal presentation.
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Healthy volunteers: No
Study design
- Observational model
- Case-only
Study locations
France · 1 center
- Service de Gynécologique et d'Obstétrique - CHU de Strasbourg - France — Strasbourg
Identifiers
NCT: NCT07314970 · 9537