Effectiveness and safety of induction of labor for term breech presentations.

In term breech deliveries, vaginal delivery can be safely envisioned in some conditions (related to patient selection and obstetrician experience). Very few data are currently available, however, about the possibility of inducing labor in these situations. OBJECTIVE: To assess the effectiveness and safety of induction of labor for breech presentations. STUDY DESIGN: Retrospective comparative hospital-based study of a continuous series of term breech deliveries from 2000 to 2010. The condition of term breech newborns delivered vaginally after induction of labor was compared to that of their counterparts delivered vaginally after spontaneous labor. RESULTS: During the study period, 96 women with term fetuses in breech presentations had labor induced and 501 in spontaneous labor had attempted vaginal deliveries. Compared with spontaneous labor, induction was not associated with a significantly higher rate of cesarean delivery during labor (20.8 vs 14.8%, P=0.14), nor with poorer neonatal condition, defined either as moderate acidosis (pH<7.15; 21.6 vs 19.8%, P=0.71) or composite neonatal morbidity (2.1 vs 0.6%, P=0.16). CONCLUSION: Our data indicate that, compared with spontaneous labor, neither cervical ripening nor oxytocin induction of labor is associated with either a poorer neonatal prognosis or an excess rate of obstetric complications in term breech births, and that the success rate of induction is satisfactory.

[How to explore breast skin lesion?: Guidelines]. / Comment explorer une lésion cutanée mammaire?: recommandations.

A change in the shape or appearance of the nipple-areola complex, especially if it is unilateral and recent appearance, is a sign of underlying breast tumor. Breast imaging is then required (grade C). Any erythematous lesion of the nipple or nipple-areola can be a Paget's disease, an adenoma of the nipple or a nipple eczema. Clinical course and pattern can point to a diagnosis without sufficient specificity (LE4). If nipple eczema is suspected, it is recommended to perform a test treatment with topical corticosteroids. In case of failure or if a Paget's disease of the breast is suspected, a biopsy must be done. When indicated, it is not possible to recommend a biopsy modality (scrape cytology, punch biopsy, nipple core biopsy and surgical excision) compared to another. When imaging exploration of the nipple-areola complex is necessary, ultrasound and mammography are recommended as first-line. In the absence of signal, an MRI is recommended as second-line (grade C).

[Benign breast tumors: Recommendations of Collège National des Gynécologues Obstétriciens Français (CNGOF)--Short text]. / Tumeurs bénignes du sein: recommandations pour la pratique clinique du Collège national des gynécologues et obstétriciens français (CNGOF)--Texte court.

Breast sonography is required with mammogram to explore clinical breast mass (grade B), colored unipore breast nipple discharge (grade C), or mastitis (grade C). Bi-RADS system is recommended to describe and classify breast-imaging abnormalities. For breast abscess, a percutaneous biopsy is recommended in case of mass or persistent symptoms (grade C). For mastodynia, when breast imaging is normal, no MRI neither breast biopsy is recommended (grade C). Percutaneous biopsy is recommended for BI-RADS 4-5 mass (grade B). For persistent erythematous breast nipple or atypical eczema lesion, a nipple biopsy is recommended (grade C). For distortion and asymmetry, a vacuum core needle biopsy is recommended because of the risk of underestimation by simple core needle biopsy (grade C). For BI-RADS 4-5 microcalcifications without ultrasound signal, a vacuum core needle biopsy of at least 11 gauges is recommended (grade B); in the absence of microcalcifications on radiograph carrots, additional samples are recommended (grade B). For atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ, flat epithelial with atypia, radial scar, mucocele with atypia, surgical excision is commonly recommended (grade C). Expectant management is feasible after multidisciplinary concertation. For these lesions, when excision is not in sano, no new excision is recommended except for pleomorphic or with necrosis CLIS (grade C). For grade 1 phyllode tumour, in sano surgical resection is recommended; for grade 2 phyllode, 10-mm margins are recommended (grade C). For breast papillary without atypia, complete disappearance of the radiologic signal is recommended (grade C). For breast papillary with atypia, complete surgical excision is recommended (grade C).

[Assessment of vacuum-assisted vaginal delivery in a frank breech presentation]. / Peut-on réaliser une extraction par ventouse obstétricale en cas de fœtus en présentation du siège décomplété ?

OBJECTIVES: After verification of the eligibility criteria and with an obstetrician familiar with the specific maneuvers likely to be needed, vaginal delivery of breech presentations is possible. If problems arise during the active pushing phase of labor, vacuum extraction has been described in the literature for this uncommon condition with limited series. The aim of this study is to assess retrospectively vacuum extraction in frank breech presentation in our center. PATIENTS AND METHODS: This retrospective study of trials of vaginal delivery of fetuses in breech presentation at term compares cases according to whether they did or did not use a vacuum extraction. RESULTS: During a two-year period, 83 patients, whom had trials of vaginal delivery in breech presentations, reached the active pushing/bearing down stage after complete cervical dilatation. Vacuum assistance was applied in six of these (7.2 %). The failure rate for vaginal delivery was significantly higher in the group with compared to without vacuum extraction (33.3 % versus 6.5 %, P<0.05). Moreover, the mean pH at birth was significantly lower in the group with vacuum extraction (7.12±0.11 versus 7.20±0.08, P<0.05), and these infants more frequently had deep cutaneous injuries (66.7 % versus 26.0 %, P<0.05). DISCUSSION AND CONCLUSION: In fetuses in breech presentation, when vaginal delivery failed, it seems to be safer for the fetuses to perform caesarean section rather than attempt vacuum extraction.