Abstract
OBJECTIVE: This large cohort study investigates the impact of premature rupture of membranes (PROM) on maternal and neonatal outcomes in breech deliveries. The aim is to contribute to a better understanding of vaginal breech delivery and its possible risk factors and to facilitate more informed decision-making within the counseling process. This study compares perinatal outcomes in vaginally planned breech deliveries with and without PROM at term. METHODS: A total of 2876 women with singleton breech presentation between 2007 and 2023 were included on this prospective cohort registry study. Among 1920 with intended vaginal delivery, 642 experienced PROM, while 1278 had spontaneous rupture of membranes (SROM). Of the women with PROM, 397 completed vaginal delivery, while the remainder underwent cesarean section after the onset of labor or after a PROM. Maternal and fetal outcome parameters were compared between groups using Pearson's χ(2)-test, the Kruskal-Wallis test, and multivariate regression analysis with Spearman's ρ correlation while a significance level of P < 0.05 applied. RESULTS: No differences in maternal and fetal outcome were observed regarding the timing of membrane rupture in vaginally planned or completed breech deliveries at term. Fetal outcome parameters, including those measured by the modified PREMODA score, showed no significant difference in relation to intended vaginal breech delivery with PROM (PROM: 2.2%, SROM: 1.4%, P = 0.212). None of the maternal outcome parameters showed a significant difference between the two groups. A significant association was found between an increased maternal body mass index and the prevalence of PROM in breech presentation (PROM: 23.5 ± 4.2 kg/m(2), SROM: 22.9 ± 3.7 kg/m(2), P = 0.007). There was an increased rate of epidural anesthesia in the PROM group compared to the SROM group (PROM: 307 [57.6%], SROM: 661 [51.7%], P = 0.014). CONCLUSION: This study supports the proposition that PROM has little to no impact on the fetal and maternal outcome of breech deliveries. With appropriate expertise, based on these data, PROM cannot be considered a risk factor for adverse outcome in vaginal breech delivery. It should be noted that women delivering vaginally with a breech presentation and PROM at term might have a higher need for epidural anesthesia. Clinical management of cases with PROM can follow that of pregnancies with cephalic presentation.