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PubMed2004

Maternal outcomes at 2 years after planned cesarean section versus planned vaginal birth for breech presentation at term: the international randomized Term Breech Trial.

OBJECTIVE: This study was undertaken to compare maternal outcomes at 2 years postpartum after planned cesarean section and planned vaginal birth for the singleton fetus in breech presentation at term. STUDY DESIGN: In selected centers in the Term Breech Trial, mothers completed a structured questionnaire at 2 or more years postpartum to determine their health in the previous 3 to 6 months. RESULTS: A total of 917 of 1159 (79.1%) mothers from 85 centers completed a follow-up questionnaire at 2 years postpartum. There were no differences between groups in breast feeding, relationship with child or partner, pain, subsequent pregnancy, incontinence, depression, urinary, menstrual or sexual problems, fatigue, or distressing memories of the birth experience. Planned cesarean section was associated with a higher risk of constipation (P = .02). CONCLUSION: Maternal outcomes at 2 years postpartum are similar after planned cesarean section and planned vaginal birth for the singleton breech fetus at term.

Adult↗
PubMed1984

[Breech presentation: cesarean section or vaginal delivery?].

The Authors studied breech presentation rate occurred in the Institute of Obstetrics and Gynecology of University of Parma during 1983. Perinatal morbidity and mortality occurred after vaginal delivery was also compared with those occurred after both emergency and elective cesarean section. Breech presentation delivery vaginally in 12,91% and by cesarean section in 87,09%. Only one case of perinatal death occurred in 1983 and it was not related to breech presentation. Breech delivery showed the 31,18% of neonatal morbidity with an higher rate in case of vaginal delivery (66,66%). In conclusion the Author's opinion is that vaginal breech delivery should be explained in a few cases according to all possible hazards.

Breech Presentation↗
PubMed1986

[Management of full term breech presentation--criteria for safe vaginal delivery (without extraction of the breech head)].

It is very important to appraise cephalo-pelvic disproportion (CPD), and to predict the necessity of extraction of the after-coming head on full-term breech presentation. Subjects were 47 cases of full-term breech presentation which delivered at our hospital during the 5-year period from 1979 to 1983. They were divided into the following groups: group A Assisted breech delivery. group B Extraction of after-coming head. group C Abdominal delivery for secondary inertia. In each case we subtracted the fetal occipitofrontal diameter from the individual pelvic diameter and compared the results for groups A and B. There were significant differences between groups A and B in the mean values (cm) for the following: True antero-posterior diameter of the wide; 1.341 +/- 1.009 and 0.380 +/- 0.379 (p less than 0.001). Antero-posterior diameter of the Fukushima's wide; 2.005 +/- 0.906 and 0.860 +/- 0.502 (p less than 0.01). Posterior-sagittal diameter of the wide; -5.300 +/- 1.026 and -6.020 +/- 0.340 (p less than 0.05). Antero-posterior diameter of the midpelvis; 1.414 +/- 1.035 and -0.110 +/- 0.718 Posterior-sagittal diameter of the midpelvis (Caldwell-Moloy); -5.759 +/- 1.041 and -6.560 +/- 0.573 (p less than 0.05). Posteriol-sagittal diameter of the midpelvis (Thoms): -6.173 +/- 1.083 and -7.430 +/- 0.750 (p less than 0.01). Furthermore, there were also significant differences between groups A and C: The margins of safety values for each pelvic diameter (cm) were as follows: Antero-posterior diameter of the midpelvis; (13.1): Posterior-sagittal diameter of the midpelvis (Thoms); (5.5): Inter-spinous diameter; (11.0): Inter-tuberous diameter; (11.3).(ABSTRACT TRUNCATED AT 250 WORDS)

Birth Weight↗
PubMed2004

Outcomes of children at 2 years after planned cesarean birth versus planned vaginal birth for breech presentation at term: the International Randomized Term Breech Trial.

OBJECTIVE: The purpose of this study was to determine whether planned cesarean delivery for the singleton fetus in breech presentation at term reduces the risk of death or neurodevelopmental delay at 2 years of age. STUDY DESIGN: In selected centers in the Term Breech Trial, children were screened for abnormalities at > or =2 years of age with the Ages and Stages Questionnaire, followed by a neurodevelopmental assessment if the Ages and Stages Questionnaire score was abnormal. RESULTS: A total of 923 of 1159 children (79.6%) from 85 centers were followed to 2 years of age. The risk of death or neurodevelopmental delay was no different for the planned cesarean than for the planned vaginal birth groups (14 children [3.1%] vs 13 children [2.8%]; relative risk, 1.09; 95% CI, 0.52- 2.30; P = .85; risk difference, +0.3%; 95% CI, -1.9%, +2.4%). CONCLUSION: Planned cesarean delivery is not associated with a reduction in risk of death or neurodevelopmental delay in children at 2 years of age.

Breech Presentation↗
PubMed1993

Breech presentation in South Australia, 1987-1989.

This study compares the maternal, obstetrical, labour and pregnancy outcome characteristics of 2,412 breech-presenting births with 17,946 vertex-presenting births. Mothers of babies presenting as breeches were significantly more likely to have had a previous miscarriage, an obstetric complication, a threatened miscarriage or threatened labour during the current pregnancy, or Caesarean section than mothers of babies with vertex presentation. The babies presenting as breeches had significantly more neonatal morbidity and perinatal mortality. They showed higher rates of suspected intrauterine growth retardation, prematurity, low birth-weight, low Apgar scores and congenital anomalies. The overall perinatal mortality for breech presentations was almost 9 times higher than for vertex presentations. Unconditional multiple logistic regression analysis showed that, even after adjusting for low birth-weight and the presence of congenital anomalies, breech presentation still showed a statistically significant association with perinatal death. The study alludes to the possibility that breech presentation, in a significant number of cases, may not be coincidental but a marker for some preconceptional or prenatal disturbance. The study also shows an excess of breech presentations in females which is unexplained and may point to a genetic or hormonal susceptibility of the fetus.

Adult↗
PubMed2002

What are the implications for the next delivery in primigravidae who have an elective caesarean section for breech presentation?

OBJECTIVE: To determine the mode of the next delivery for primigravid women who have an elective caesarean section for breech presentation. DESIGN: Retrospective cohort study. SETTING: University teaching hospital. POPULATION: All primigravid women who had an elective caesarean section for a singleton pregnancy in the years 1992 to 1997 and who delivered their next baby in the hospital before 1999. METHODS: Review of hospital computerised records. MAIN OUTCOME MEASURES: Mode of delivery and fetal presentation at next delivery. RESULTS: Of 194 women who had an elective caesarean section with a breech presentation as a primigravida, 19 (9.8%) had a breech presentation at the time of elective caesarean section for their next baby compared with only two (1.7%) in the 121 women who had an elective caesarean section with a cephalic presentation as a primigravida (RR 5.9 [95% CI 1.4-25.0]). Despite the increased likelihood of another breech presentation, the overall repeat section rate was 43.8% (n = 85) in women with a previous breech presentation (n = 194), compared with 61.2% (n = 74) in women with a previous cephalic presentation (n = 121) (RR 0.72 [95% CI 0.58-0.89]). Of those women allowed to labour after elective caesarean section as a primigravid, the vaginal birth rate was 109/130 (84%) if the presentation previously was breech compared with 47/69 (68%) if the presentation previously was cephalic (RR 1.2 [95% CI 1.03-1.50]). CONCLUSIONS: Women who have an elective caesarean section for a breech presentation in their first pregnancy have about a 1 in 10 chance of having an elective caesarean section for a breech presentation in their second pregnancy. Overall, the incidence of repeat caesarean section for their second baby was 43.8%, and of those allowed to labour, 84% achieved a vaginal delivery. These results compared favourably with women who had an elective caesarean section with a cephalic presentation in their first pregnancy. This information is important in advising primigravid women with a breech presentation about longer term implications of elective caesarean section. It also allows healthcare managers to anticipate the resource implications of any changes in clinical practice for women with a breech presentation in their first pregnancy.

Breech Presentation↗
PubMed1994

Favorable neonatal outcome after fetal entrapment and partially successful Zavanelli maneuver in a case of breech presentation.

A 16-year-old primigravida woman presented in advanced labor with a singleton breech presentation. Vaginal delivery was considered to be possible, but entrapment at the level of the fetal thorax occurred. The Zavanelli maneuver was attempted unsuccessfully. A cesarean section was performed immediately but was complicated by lateroflexion of the fetus. The attending pediatrician proceeded to endotracheal intubation and ventilation of the partially born baby. Repositioning of the mother facilitated delivery. The fetus survived without any complications. This case illustrates the lack of scientific data to support decision-making in the case of patients presenting with breech presentation late in labor, as well as the unconventional steps sometimes needed in these situations.

Adolescent↗
PubMed1993

Breech presentation.

This review covers recent literature relevant to breech presentation. Some have advocated routine elective cesarean delivery of the breech fetus of any gestational age to reduce the alleged increase in perinatal morbidity and mortality associated with breech presentation. This indication for cesarean delivery accounts for approximately 15% of all cesarean deliveries and costs society approximately US$ 1.4 billion per year. As a result of concerns with vaginal breech delivery, external cephalic version in the term fetus has become well accepted. A new scoring system has been developed to predict the success of external cephalic version. Repeated external cephalic version has been shown to be successful. Careful ultrasound continues to be important before the procedure. It has been suggested that magnetic resonance pelvimetry may be a practical alternative in evaluating candidates for breech vaginal delivery. There is still no compelling prospective data supporting cesarean delivery for preterm breech presentation. Legal considerations have prevented many from attempting vaginal breech delivery, even in carefully selected patients.

Breech Presentation↗
PubMed2004

Acupuncture plus moxibustion to resolve breech presentation: a randomized controlled study.

OBJECTIVE: In many Western countries breech presentation is an indication for elective Cesarean section. In order to correct fetal presentation, the stimulation of the acupoint BL67 by moxibustion, acupuncture or both has been proposed. Since no studies had previously been carried out on Western populations, pregnant Italian women at 33-35 weeks gestational age carrying a fetus in breech presentation were enrolled in a randomized, controlled trial involving an active BL67 point stimulation and an observation group. METHODS: A total of 240 women at 33-35 weeks of gestation carrying a fetus in breech presentation were randomized to receive active treatment (acupuncture plus moxibustion) or to be assigned to the observation group. Bilateral acupuncture plus moxibustion was applied at the BL67 acupoint (Zhiyin). The primary outcome of the study was fetal presentation at delivery. RESULTS: Fourteen cases dropped out. The final analysis was thus made on 226 cases, 114 randomized to observation and 112 to acupuncture plus moxibustion. At delivery, the proportion of cephalic version was lower in the observation group (36.7%) than in the active-treatment group (53.6 %) (p = 0.01). Hence, the proportion of Cesarean sections indicated for breech presentation was significantly lower in the treatment group than in the observation group (52.3% vs. 66.7%, p = 0.03). CONCLUSIONS: Acupuncture plus moxibustion is more effective than observation in revolving fetuses in breech presentation. Such a method appears to be a valid option for women willing to experience a natural birth.

Acupuncture↗
PubMed1992

[Risks for neonates born in the breech presentation].

A prospective study included 106 females and their newborns, 45 of them born in breech presentation and 61 delivered normally. The incidence of prepathologic and pathologic CTG records and meconial amniotic fluid is significant (0.01), more frequent in breech presentation (24.44% and 22.2%) than in normal deliveries (8.20% and 9.84%). Children born in breech presentation have significantly (p < 0.005) lower Apgar score values after the 1st and 5th minute than the control children. Infants born in breech presentation have significantly (p < 0.01) lower pH values (7.25 +/- 0.093) than those delivered normally (7.30 +/- 0.056). The acidosis incidence (pH < 7.20) in the studied group was 26.66% and 3.38% in the control group. In early neonatal period the disease occurred in 35.55% of the breech presentation group and 9.83% of the normal group (p < 0.01). In the control group there was no intracranial hemorrhages and manifest cerebral disfunction--complications most frequently involved in perinatal morbidity of children born in breech presentation (17.77% and 8.88%). One (2.22%) child born in breech presentation died in the early neonatal period.

Breech Presentation↗
PubMed1999

Comparison of vaginal and cesarean section delivery for fetuses in breech presentation.

OBJECTIVES: Our purpose was to evaluate the perinatal mortality and morbidity of deliveries with fetuses presenting by the breech comparing outcomes of two groups according to mode of delivery: vaginal and cesarean section. RESULTS: Of 756 fetuses studied, 271 were delivered vaginally and 485 by cesarean section. In infants weighing > or = 1500 grams, "further corrected" mortality and morbidity rates were low and similar for both delivery routes: one neonatal death (NNM) in each. Among very low birth weight (VLBW) infants (< 1500 grams) the "further corrected" mortality rate was higher in the vaginal group: 57.4%, and 18.0% in abdominal deliveries (odds ratio [OR] = 6.1, 95% CI: 3.1 to 12.1). Likewise, rate of depression at five minutes were higher in the vaginal group (p < 0.001). However, the average fetal weight among the vaginal deliveries VLBW (787 grams) was 250 grams less than in the cesarean section group (1040 grams). After adjustment for fetal weight, gestational age, and other prognostic variables the odds ratio for neonatal death was no longer statistically significant (adjusted OR = 2.1, 95% CI: 0.9 to 5.2, p = 0.105). Comparison of planned vaginal delivery with elective cesarean section yielded smaller differences (adjusted OR for neonatal death = 1.3, 95% CI: 0.6 to 2.9, p = 0.525). CONCLUSION: The poor perinatal outcomes of breech delivered infants are due primarily to VLBW, congenital malformations, and premature labor. Although abdominal delivery had a lower NNM rate than vaginal delivery, the difference was not significant after adjustment for confounding factors. The results confirm the findings of a previously analyzed similar series delivered at our institution between 1980 and 1987. They suggest that, with appropriate technique, abdominal delivery is not mandatory in breech presentation.

Adult↗
PubMed2002

Changing attitudes toward mode of delivery and external cephalic version in breech presentations.

OBJECTIVES: To compare the attitude of gravid women in breech presentation towards external cephalic version (ECV) and mode of delivery between 1995 and 2001. METHODS: A questionnaire on ECV and mode of delivery was distributed to women in the third trimester of pregnancy with breech presentation, attending our departmental clinic for a routine check-up once in 1995 and again in 2001 in order to analyze changing attitudes. RESULTS: One hundred fifty-four women completed the questionnaire in 1995 and 127 in 2001. There were no statistically significant differences between the groups in age, gestational age, gravidity, parity, or level of education. In 1995, more than half the women (52.7%) had heard of ECV and 53.8% were willing to consider it, whereas in 2001, 73.2% had heard of it but only 23.9% were willing to consider it. In both groups, the women who were familiar with ECV were more likely to work outside of the home, have a higher level of educated than the women who were not. The women who were willing to try ECV were more likely not to work outside of the home, to consider their pregnancy low risk, and to opt for vaginal delivery (vs. cesarean section) if ECV did not succeed. The percentage of women who would choose planned cesarean section if the presentation remained breech was significantly higher in 2001 (97%) than in 1995 (64.7%). CONCLUSIONS: Attitudes toward breech delivery have changed since 1995. More women are aware of the option of ECV but are less inclined to consider it. Planned cesarean section for breech presentation is the overwhelming choice of women in general, with a significant increase in 2001 compared with 1995.

Adult↗
PubMed1976

Extradural analgesia in labour when the breech presents.

A retrospective study was made of the course and outcome of labour in 226 patients in whom a singleton fetus presented by the breech. Patients with macerated stillbirths or who were delivered before the 28th week of gestation had been excluded. Of the 226 patients, 101 received extradural analgesia, 79 received parenteral analgesia and 46 underwent elective Caesarean section. There was no difference in the incidence of breech extraction or emergency Caesarean section in the first two groups of patients. The length of both first and second stages of labour in multiparae was prolonged in the extradural group, but not markedly so. The Apgar scores of the infants delivered vaginally were not significantly different at one minute in both groups but the five minute Apgar score in the infants of primiparae was significantly higher in the extradural group. The Apgar score at one minute in the group delivered by emergency Caesarean section was significantly lower after extradural block but the difference was not significant at five minutes. This study suggests that the management and outcome of labour when the breech presents is not adversely affected by the provision of extradural analgesia.

Adult↗
PubMed2000

Secular trends in peri- and neonatal mortality in breech presentation; Norway 1967-1994.

OBJECTIVES: To assess secular trends in mortality rates in breech presentation in Norway and the effects of gestational age, birth defects and delivery method. MATERIAL AND METHODS: The Medical Birth Registry of Norway 1967-1994, with 45,579 breech presentation births from 24 weeks of gestation onwards, with mortality rate comprising all stillbirths from 24 completed weeks of gestation and all neonatal deaths (extended peri- and neonatal mortality) as main outcome variable. RESULTS: The extended peri- and neonatal mortality rate in breech presentation births declined during the study period from 9.2% in 1967-76 to 5.5% in 1977-86 and to 3.0% in 1987-94. The highest relative risk of mortality in breech presentation versus the total birth population was observed in intrapartum death and in mortality less than 24 hours after delivery. Stillbirth represented about half of the extended peri- and neonatal mortality throughout the study period. Also in infants with birth defects, the survival increased during the study period. The extended peri- and neonatal mortality was highest in vaginal deliveries, but decreased during the period, irrespective of delivery method. CONCLUSIONS: Probably due to improved obstetrical and neonatal care, mortality associated with breech presentation has substantially decreased. Increased focus especially on stillbirth, might be instrumental in further reducing the mortality associated with breech presentation.

Adult↗
PubMed1975

[Tocolysis for external version of breech presentation close to term (authors transl)].

The external version of breech presentation into vertex presentation with tocolysis near term is now the best method to avoid the disadvantages of a breech presentation for mother and child. In 30 out of 37 cases external version using Partusisten was possible. 26 patients with previous breech presentation were, after version, delivered of a healthy child. Except for one transitory slight hemorrhage there were no incidents. This method should be carried out only in a department having facilities for cardiotocography and emergency Caesarian section. It appears that a cause of failur of the external version with tocolysis near term is the breech presentation with extended legs.

Breech Presentation↗
PubMed2005

Mothers' views of their childbirth experiences 2 years after planned Caesarean versus planned vaginal birth for breech presentation at term, in the international randomized Term Breech Trial.

OBJECTIVE: To compare mothers' views at 2 years postpartum after participation in a randomized trial of planned Caesarean and planned vaginal birth for a singleton fetus in breech presentation at term. STUDY DESIGN: In selected centres in the Term Breech Trial, mothers completed a structured questionnaire at approximately 2 years postpartum to assess their likes and dislikes about their childbirth experiences and their views about their intrapartum care and care providers. RESULTS: Of 1159 mothers from 85 centres, 917 (79.1%) completed a follow-up questionnaire at 2 years postpartum. Baseline information was similar for both the planned Caesarean and planned vaginal birth groups. Planned Caesarean was associated with less worry about the baby's health (P < 0.001). While other differences were noted in likes and dislikes about their childbirth experiences, women's evaluations of the quality of intrapartum care, the helpfulness of staff, and their involvement in decision-making did not differ in the planned Caesarean delivery and planned vaginal birth groups. CONCLUSION: Planned mode of delivery influences aspects of women's evaluations of their childbirth experiences but does not affect evaluations of the quality of intrapartum care, support from care providers, or amount of involvement in decision-making.

Breech Presentation↗
PubMed2000

Intrapartum external cephalic version of footling-breech presentation.

BACKGROUND: External cephalic version is attempted prior to the onset of labor. Women who present in labor with footling breech presentation are usually delivered by cesarean section. We present our experience of external version in women in labor. MATERIAL AND METHODS: External cephalic version was attempted in thirteen patients in labor with footling breech presentation with the breech out of the pelvis. RESULTS: The procedure was successful in twelve of the thirteen patients. Ten of them delivered vaginally. There were no maternal or neonatal complications. CONCLUSIONS: It may be reasonable to attempt external cephalic version in patients in labor prior to performing a cesarean section.

Adult↗
PubMed1994

Mode of delivery and perinatal results in breech presentation.

OBJECTIVES: Our purpose was to evaluate the outcome of deliveries with fetuses in breech presentation at labor and to compare the results by route of delivery. Specially reviewed were fetuses weighing > or = 1500 gm. STUDY DESIGN: An observational study of consecutive cases of all singleton pregnancies and twin pregnancies with the first fetus presenting in breech delivered at Chicago Lying-In Hospital from July 1980 to December 1987 was performed. Crude perinatal mortality and effect of mode of delivery (cesarean vs vaginal) by weight were compared after correction for nonpreventable causes. A further correction was made for fetuses weighing > or = 1500 gm by excluding all cases of fetal distress from the cesarean section group. All clinically relevant factors were evaluated. Statistical methods included comparison of frequencies in the two groups by chi 2 and Fisher exact tests and comparison of means by two-sample t tests. RESULTS: Of 21,380 deliveries, 843 (3.9%) presented by the breech. Forty-four percent were delivered vaginally; 8.4% were first twins. There were 51% preterm infants, and 24% had clinical distress. Crude perinatal mortality was 24%; 8% stillborns, 10% from prematurity, and 6% from other causes, including lethal congenital malformations. The corrected perinatal mortality was 15%. Vaginal deliveries had a higher 5-minute depression rate (32% vs 24%) and corrected perinatal mortality (23% vs 9.6%); however, fetal weights were significantly lower. There were no differences in outcomes for newborns weighing > or = 1500 gm by route of delivery; all five neonatal deaths in this subgroup occurred among the abdominal deliveries. CONCLUSIONS: The very poor perinatal outcomes in breeches are primarily related to factors other than breech presentation. Route of delivery for infants weighing > or = 1500 gm does not influence neonatal outcome; thus cesarean section solely for breech presentation in this subgroup does not appear to be justified.

Adolescent↗