[Assisted vaginal delivery using the vacuum extractor in frank breech presentation].

OBJECTIVES: When all the breech conditions for the acceptance of a vaginal breech birth are present, we occasionally practise a total breech extraction for non frank breech presentations. Similarly, for frank breech presentations, instead of using the fetal leg as tractor, we sometimes apply the vacuum extractor on the breech presentation in order to perform the first step of the total breech extraction. The vacuum extractor is not traumatic for the fetus and enable a quick extraction. This study was conducted to describe the technique we use in our ward.

PATIENTS AND METHODS: A retrospective study including every singleton delivery with a breech presentation and a tried and assisted vaginal delivery using the vacuum extractor in our maternity ward from 1994 to 2004. A descriptive analysis of maternal, fetal and obstetrical elements has been carried out.

RESULTS: Twenty-eight deliveries were indexed. In each case, a vaginal delivery was performed. Neonatal outcomes were satisfactory with a five minutes Apgar score always higher than 7. In all 96.5% of the extractions were realized under pelvic level +2. The main indication of extraction (78.5%) was a second stage of labour which was too long.

CONCLUSION: Obstetricians should know several techniques to accept and to manage breech deliveries. Indications for assisted vaginal delivery using the vacuum extractor in frank breech presentation are unusual, concerning delay in the second stage with an engaged foetus. This technique may avoid some cesarean sections. Nevertheless vaginal breech delivery try should be happening with great caution and with a strict patient's eligibility.