PubMed · 12026803
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R Weston. 2001. When birth goes wrong.. https://pubmed.ncbi.nlm.nih.gov/12026803/
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BACKGROUND: Women's right to decide on the mode of delivery is discussed, as well as the management of term breech deliveries. Obstetric practice may have changed as a consequence of ongoing debates. National caesarean section rates were stable at 12-13% during the 1990s, but no information has been provided about the development over the last two years. MATERIAL AND METHODS: Information about deliveries in obstetrical units in Norway, 1999 to 2002, was extracted from the Norwegian Patient Register. The number of deliveries was validated against information from Statistics Norway. The numbers of caesarean sections in 1999 and 2000 were validated against information from the Medical Birth Registry of Norway. RESULTS: The caesarean section rate increased slightly from 12.8% in 1999 to 13.0% in 2000. In 2001, there was a considerable increase to 14.9%; during the first 8 months of 2002, the rate was 15.1%. The change in practice appeared in the last months of 2000, coinciding with the publication of the term breech trial. However, only about one third of the increase can be attributed to a change in breech delivery. COMMENTS. Caesarean section is the most frequent major surgical procedure performed on hospitalised patients. In times of rapid changes in obstetric practice, monitoring of the development without time delay is called for.
OBJECTIVES: To compare neonatal morbidity of breech and cephalic deliveries at term. STUDY DESIGN: Cohort study of 610 consecutive singleton breech presentations and 12,405 consecutive singleton cephalic presentations in term between 1992-1998. Five hundred and fourteen breech and 11,989 cephalic presentations were candidates for vaginal delivery, of which 407 (79%) breeches and 11,265 (94%) cephalic delivered vaginally. RESULTS: Neonatal intensive care admissions were significantly greater for breech than cephalic vaginal deliveries (2.7% versus 0.25%, P = 0.000), but newborn intensive care admission and mortality were equally distributed between the two groups. CONCLUSIONS: A low caesarean rate is possible (21% beech and 6% cephalic). Neonatal morbidity was equal in the two populations. Admission to neonatal intensive care was significantly more frequent for caesarean section than for vaginal delivery in the cephalic group and equal in the breech group. This study justifies our obstetrical policy and the realisation of a trial in several centres similar in terms of perinatal management.
Through a retrospective review of our own materials and data from peer-reviewed journals, among medical entities a greater probability than 0.5 was not found for breech presentation. Submitting the occurrence of breech presentation to the classical laws of probability means that each fetus in breech presentation has its 'pair' in cephalic presentation. Among medical entities with a probability of less than 0.5 for breech presentation, the group of fetuses in cephalic presentation consist of two subgroups: (1) fetuses which are by chance in cephalic presentation and whose number is identical to the number of fetuses in breech presentation, (2) fetuses which are in cephalic presentation because of the postural development. Likewise, introducing a medical entity with a small number of cases does not allow a conclusion to be drawn about a relationship between that entity and breech presentation.