Impact périnéal de l’accouchement d’un fœtus en présentation du siège

Overview & Synopsis

Obstetrical Anal Sphincter Injuries (OASIs) are lesions occurring during delivery, responsible for anal incontinence, dyspareunia, pain, and rectovaginal fistula. These types of lesions and their incidence have been well studied after cephalic presentation delivery, but no publication have already specifically studied them after vaginal breech delivery. The goal of our study was to evaluate the incidence of OASIs in breech delivery and compare it with cephalic presentation. Methods: we included 670 patients: 224 patients delivered from a fetus in breech presentation and 446 delivered from a fetus in cephalic presentation. Both groups were matched on fetal weight (± 200 g), date of delivery (± 2 years) and parity. Main objective was to evaluate the incidence of OASIs in breech presentation, compared to cephalic presentation. Secondary endpoints were the incidence of intact or first-degree perineum, second-degree perineum, episiotomies in each group and risk factors for OASIs. Results: there was no statistically significant difference between breech and cephalic groups on the incidence of OASIs (OR: 0.772 (0.133; 4.479), p=0.77)). The rate of OASIS in the breech group was low (0.9%) and not higher than in the cephalic group (1.1%). There were more episiotomies in the breech group (12.5% vs 5.4%, p=0.0012) and the rate of intact or first-degree perineum was similar in both groups (74.1% vs 75.3%, p=0.7291). Factors associated with OASIs in our study were the total duration of labor (p=0.19) and parity (p=0.1026). Conclusion: OASIs was a rare event in our study, and we did not show any difference on the incidence of OASIs between women who delivered of a fetus in breech presentation, compared to a cephalic presentation. This result should be confirmed by further studies including more patients.