PubMed · 7848255
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M Shembrey. 1994. 'More information please'.. https://pubmed.ncbi.nlm.nih.gov/7848255/
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BACKGROUND: The optimal mode of delivery for a second twin in breech position is controversial, with support for both caesarean and vaginal delivery. OBJECTIVES: The objective of this review was to assess the effects of caesarean delivery compared with vaginal delivery of a second twin not presenting cephalically. SEARCH STRATEGY: The Cochrane Pregnancy and Childbirth Group trials register, Cochrane Controlled Trials Register, and bibliographies up to December 1998. SELECTION CRITERIA: Randomised trials of Caesarean delivery compared with vaginal delivery in women with a twin pregnancy where the second twin is not presenting cephalically. DATA COLLECTION AND ANALYSIS: All assessments of trial eligibility, quality and data extractions were done by the author without blinding. MAIN RESULTS: One trial involving 60 pairs of twins was included. Maternal febrile morbidity were increased in women allocated to the caesarean group (relative risk (RR) 3.67, 95% confidence interval (CI) 1.15-11.69), and there was a trend to an increased need for use of general anaesthesia (RR 2.40, 95% CI 0. 98-5.88). No differences were detected in neonatal outcome. REVIEWER'S CONCLUSIONS: caesarean section for delivery of a second twin not presenting cephalically is associated with increased maternal febrile morbidity with, as yet, no identified improvement in neonatal outcome. This policy should not be adopted except within the context of further controlled trials
BACKGROUND: It is possible that maternal posture may influence fetal position. Many postural techniques have been used to promote cephalic version. OBJECTIVES: The objective of this review was to assess the effects of postural management of breech presentation on measures of pregnancy outcome. SEARCH STRATEGY: The Cochrane Pregnancy and Childbirth trials register and Controlled Trials Register were searched. Date of last search: February 1999. SELECTION CRITERIA: Randomised and quasi-randomised trials comparing postural management with pelvic elevation for breech presentation, with a control group. DATA COLLECTION AND ANALYSIS: Eligibility and trial quality were assessed by both reviewers. MAIN RESULTS: Three studies involving a total of 192 women were included. Postural management was associated with a non-significant trend towards fewer non-cephalic births (relative risk 0.90, 95% confidence interval 0. 73 to 1.12). No differences were detected for caesarean sections or Apgar scores below seven at one minute. REVIEWER'S CONCLUSIONS: There is not enough evidence to evaluate the use of postural management for breech presentation.