PubMed · 14781518
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E MACIAS de TORRES. [Breech presentation].. https://pubmed.ncbi.nlm.nih.gov/14781518/
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Ultrasonography should benefit many pathological events which occur in delivery rooms. The authors analyse the scarce literature about this subject and propose indications in which this complementary examination seems to be interesting.
OBJECTIVES: To compare maternal and neonatal outcomes of planned vaginal delivery vs. elective cesarean delivery for breech presentation at term. METHODS: Retrospective study of term breech deliveries from January 1997 through December 2000. A group of 128 women for whom vaginal delivery was planned was compared with a group of 122 women who had an elective cesarean delivery with regard to neonatal mortality and morbidity (birth trauma, birth asphyxia, hyperbilirubinemia, and duration of stay in the neonatal intensive care unit) and maternal morbidity (infections, hemorrhage, hysterectomy, deep venous thrombosis, and pulmonary embolism). RESULTS: There was no difference in neonatal mortality and morbidity between the two groups (13.0% vs. 9.4%). There were fewer maternal complications in the planned vaginal group than in the elective cesarean group (5.5% vs. 18%; P<0.01). In the planned vaginal delivery group 70% of multiparas and 85% of grandmultiparas were delivered vaginally compared with 50% of nulliparas. CONCLUSIONS: In breech presentations at term vaginal delivery can be achieved in 85% of grandmultiparas without significant neonatal morbidity. Elective cesarean section is associated with increased maternal morbidity compared with planned vaginal delivery.
OBJECTIVES: To evaluate the effectiveness of external cephalic version for reducing the rate of cesarean section by preserving fetal safety. MATERIALS AND METHODS: A retrospective review of 237 external cephalic versions between January 1, 1998 and December 31, 2000 was conducted at Port Royal maternity. RESULTS: The success rate of external cephalic version was 50.6%. When version failed vaginal birth could be allowed after strict evaluation. The rate of cesarean section was 12.5% in the success group and 53% in the unsuccessful group, two thirds were planned. The overall rate of vaginal birth among breech presentations was 67%. After version there were 3.4% abnormal fetal heart rate tracings and 2.9% positive Kleihauer tests. No major complications occurred. Successful external cephalic version was associated with statistically significant higher multiparity, complete breech out of the pelvis and normal amniotic fluid Volume. CONCLUSION: External cephalic version reduces the cesarean section rate by about 20.5% among breech presentations and so, lowers maternal morbidity. External cephalic version could be proposed to the patients when safety criteria are respected and close fetal monitoring is maintained.