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The frequency of caesarean section is increasing. A corresponding reason for this development is the increasing quota of primary caesarean section in patients with breech presentation. The aim of this study was to extend the expectation- fear- and information-profile in these patients and therefore the influence on the caesarean section rate. 100 patients with breech presentation were randomized and prospectively questionnaired. In summary, the study shows that women with breech presentation prefer primary caesarean section as the favourite delivery mode. Fears experienced before the delivery were focused accordingly on the condition of the child were in conflict to the higher incidence of maternal risk factors. Only an objective clearing of the obstetrical conditions and risk factors of the delivery modes (vaginal delivery mode, caesarean section) can induce patient's compliance which is the presupposition for a vaginal delivery mode of breech presentation.
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OBJECTIVES: To describe the evolution of medical practices in breech presentation at term and to compare early neonatal complications according to initial obstetrical decision on the type of delivery. METHODS: 71919 pregnancies are included in the AUDIPOG Database from 1994 to 2000. Among this cohort, pregnant women with a singleton in breech, at term were selected which represented 2136 women after the exclusion of in utero deaths and medical abortions. The first outcome was global criteria of severe early neonatal complications ("death during per or immediate post partum or transfer of the newborns to an intensive care or surgery unit"). The size of the sample authorized a power of 90%. RESULTS: The rate of cesarean section before labor was 40%. We found 2.3% of early neonatal complications in the group in which labor was accepted vs. 1.9% in the group with cesarean section performed before labor (p>0.05). After having taken into account prognostic factors, we do not see a significant difference for the risk of neonatal complications between the two groups (OR=1.33; 95% CI: 0.63-2.80). CONCLUSION: The analysis of the AUDIPOG Database describes the French obstetrical practice in breech presentation at term. We do not find a different risk in morbi-mortality as regards to the initial obstetrical choice regarding the type of delivery, but the absence of randomization in our study does not authorize a strong medical evidence to guide national recommendations.
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By analysing all breech presentations handled in the last three years (290 cases), the authors have found that perinatal mortality in such cases was much higher (8%) than the general perinatal mortality (1.8%) in the last years and that this increase mainly related to the perinatal mortality of children weighing less than 2500 g, owing to complications and diseases typical of that kind of children. Out of the children delivered with breech presentation, 40% were either premature babies (22%) or small-for-date babies (18%). The condition of children delivered with breech presentation is 5-6 times worse than in premature babies delivered with full or partial extraction. The authors could not establish if the condition of children with cesarean section was better. The results were obtained when the delivery was induced by using the maniotomy and Syntocinon. The authors point out that the problem of breech presentation lies in prematurity, that an excessive application of cesarean section does not solve the problem, that extractions should be avoided, and that all such deliveries should be managed on the principle of active management of labour.
UNLABELLED: The aim of this study was to evaluate the frequency and type of hip-joint instability and the frequency of hip dislocation requiring treatment in neonates who had been lying in the breech presentation and were delivered vaginally after an external version or by caesarean section, and to compare them with neonates who were naturally in the vertex presentation. Breech presentations without ongoing labour were subjected to an attempted external version and, in cases where this proved unsuccessful or where labour had started, to deliver by caesarean section. None of the breech presentations was vaginally delivered. The anterior-dynamic ultrasound method was used to assess the hip-joint status of the neonates. Out of 6,571 foetuses, 257 were in breech presentation after 36 wk of pregnancy. Sixty-two were vaginally delivered following an external version to vertex presentation and 195 were delivered by caesarean section, 75 of these following unsuccessful attempts to perform a version. Treatment for congenital hip-joint dislocation was performed on 0.2%. Out of the breech presentations, 1.0% of those delivered by caesarean section were treated, while in those with vaginal delivery following an external version the treatment frequency was 3.2%. No case of late diagnosed hip dislocation was recorded. Significant differences in frequency of hip-joint instability and treatment were found between (i) neonates delivered in breech presentation and those delivered with vertex presentation, (ii) infants delivered in vertex presentation, naturally or after successful version, and (iii) those delivered by caesarean section with or without attempted external version and those delivered with vortex presentation. CONCLUSION: Breech presentation predisposes to increased hip instability. The instability is present prior to delivery and is certainly not a primary result of delivery forces. Both breech and vertex presentations following an external or spontaneous version should be considered as risk factors for neonatal hip instability.
543 cases of breech presentation at the 1st Clinic of Obstetrics and Gynecology of the University of Vienna were investigated. The rate of Cesarean section showed during the last years a distinct increase (1969 to 1973: 16,6%, 1974 to 1977: 27,9%, 1977: 39,7%). A significant decrease of perinatal mortality in cases of breech presentation was not observed. On the other hand an increase in Cesarean sections diminishes the rate of perinatal mortality. In this publication the findings concerning the obstetrical results using abdominal or vaginal delivery are compared. No significant difference in perinatal mortality could be found. A better result could only be achieved in cases of mature infants. Our point of view is, that at present the indication of Cesarean section for cases of breech presentation should be very liberal. On the other hand vaginal delivery in some cases is still of importance.
BACKGROUND: For 3-4% of pregnancies, the fetus will be in the breech presentation at term. For most of these women, the approach to delivery is controversial. We did a randomised trial to compare a policy of planned caesarean section with a policy of planned vaginal birth for selected breech-presentation pregnancies. METHODS: At 121 centres in 26 countries, 2088 women with a singleton fetus in a frank or complete breech presentation were randomly assigned planned caesarean section or planned vaginal birth. Women having a vaginal breech delivery had an experienced clinician at the birth. Mothers and infants were followed-up to 6 weeks post partum. The primary outcomes were perinatal mortality, neonatal mortality, or serious neonatal morbidity; and maternal mortality or serious maternal morbidity. Analysis was by intention to treat. FINDINGS: Data were received for 2083 women. Of the 1041 women assigned planned caesarean section, 941 (90.4%) were delivered by caesarean section. Of the 1042 women assigned planned vaginal birth, 591 (56.7%) delivered vaginally. Perinatal mortality, neonatal mortality, or serious neonatal morbidity was significantly lower for the planned caesarean section group than for the planned vaginal birth group (17 of 1039 [1.6%] vs 52 of 1039 [5.0%]; relative risk 0.33 [95% CI 0.19-0.56]; p<0.0001). There were no differences between groups in terms of maternal mortality or serious maternal morbidity (41 of 1041 [3.9%] vs 33 of 1042 [3.2%]; 1.24 [0.79-1.95]; p=0.35). INTERPRETATION: Planned caesarean section is better than planned vaginal birth for the term fetus in the breech presentation; serious maternal complications are similar between the groups.