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PubMed1979

Minimal brain dysfunction in children born in breech presentation.

The influence of delivery in breech presentation on the occurrence of minimal brain dysfunction (MBD) has been studied. Parents of 8--15 year old children were asked to account for behavioral and educational deficits and needs of their children from birth until the date of investigation. It was found that among prematurely delivered children, the frequency of MBD, defined as hyperkinesia and learning disability, amounted to about 20 per cent and was similarly distributed between children , however, the average frequency of hyperkinesia and learning disability amounted to 8 per cent; in children born in breech presentation it was 14 per cent, while in those born in vertex presentation the corresponding figure was 2 per cent. MBD was more common in boys (16 per cent) than in girls (12 per cent).

Adolescent↗
PubMed1979

Perinatal mortality and morbidity in breech presentation.

The perinatal mortality associated with breech presentation at the Royal Women's Hospital, Melbourne, between 1974 and 1976 was 10.4%, or almost 5 times the overall hospital figure. Nine of 487 infants (1.8%) weighing greater than or equal to 2500 g died in the perinatal period, but 7 were already dead at the onset of labor or had congenital abnormalities incompatible with life. Sixty of 177 infants (33.9%) weighing 1000-2499 g died in the perinatal period, but 28 of these died due to prematurity alone or from complications of intrauterine hypoxia or birth trauma. Although elective cesarean section for breech presentation could not be justified for infants weighing greater than or equal to 2500 g, this procedure may well reduce the perinatal loss of premature infants by reducing the incidence of intrauterine hypoxia and preventing birth trauma.

Apgar Score↗
PubMed1989

[Breech presentation deliveries].

A total of 5,519 consecutive single deliveries at term were analysed for maternal and foetal factors associated with breech presentation (UK). The protocol in this department for breech deliveries which permits vaginal delivery of foetuses estimated to be between 2,400 and 3,800 g in cases where the pelvis was considered to be clinically normal, was also evaluated. Breech presentation was found in 173 cases. In 102 of these circumstances were present which permitted trial of vaginal delivery. Seventy-seven were delivered vaginally. An increased frequency of low Apgar scores (less than 8) after one minute was demonstrated among infants delivered vaginally in the breech presentation on comparison with infants delivered by Caesarean section, whereas low scoring after five minutes occurred with the same frequency. One infant died during delivery. Follow-up of infants delivered in breech presentation (mean period of observation two years) showed developmental disturbances in three of the vaginally delivered infants and in five of those delivered abdominally. Two of the infants delivered abdominally had severe cerebral paresis and psychomotor retardation without evidence of intrauterine or severe neonatal asphyxia. On comparison with the population delivered in cephalic presentation (HST), significantly increased frequencies of primiparity and light-for-dates infants were found in the breech presentations. Low Apgar score after one minute was significantly more frequent in breech presentations while low Apgar scoring after five minutes occurred with the same frequency. The perinatal mortality rates in breech and cephalic presentations were 17.3 and 4.7 per 1,000 respectively. Following correction for lethal malformations, the rates were 5.8 and 3.8 per 1,000, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Apgar Score↗
PubMed2001

[Influence of the type of breech presentation on delivery in selected primiparous women at term].

OBJECTIVE: Study the effect of the type of breech presentation on the prognosis of delivery in selected primiparous women at term. PATIENTS AND METHODS: We reviewed retrospectively 146 breech presentations seen between January 1, 1993 and December 12, 1999 in our unit. We limited our study to primiparous mothers at term (> or = 37 weeks gestation) who had had a normal single fetus pregnancy and who had accepted a trial of labor. We analyzed the mode of labor termination, and maternal, fetal, ovular, obstetrical and neonatal features by type of breech presentation and by type of delivery. We collected data by manual search of the patients' registered files (AUDIPOG). The chi-squared and Fisher's tests were used as appropriate for statistical analysis. RESULTS: Spontaneous vaginal delivery was achieved in 10.3% of the cases and non-spontaneous vaginal delivery in 56.2%. Cesarean section during labor was required in 33.5%. There was no significant difference between frank breech presentation (27.4%) and incomplete breech presentation (72.6%). Maternal, fetal, ovular, obstetrical and neonatal features were not significantly different. CONCLUSIONS: Unlike data reported by others, our series did not demonstrate any significant feature predictive of obstetrical and neonatal prognosis irrespective of the type of breech presentation in selected primiparous women at term who had had a normal pregnancy.

Adult↗
PubMed2003

Breech presentation and tossing a coin: heads or tails.

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.

Breech Presentation↗
PubMed1982

[Choice of delivery methods for cases of breech presentation, with particular reference to premature birth (author's transl)].

Overall mortality, stillbirths and neonatal deaths up to the 28th day of age included, were tested together with selected morbidity parameters, depending on delivery methods used (vaginal route or caesarean section). The group of probands included 112 single births on terms and 136 genuine single premature births (31st to 35th weeks of pregnancy), all of them delivered from breech presentation. Caesarean section for breech presentation deliveries on full term was found to be indicated primarily for cases of cephalopelvic disproportionality and severe risk factors and secondarily on account of cardiotocographic monitoring. Caesarean section has been the method of choice from 1979 for premature births from breech presentation, delivery dates being between the 31st and 35th weeks of pregnancy.--Breech presentation delivery goes along with higher morbidity or mortality risk and, therefore, has become a priority problem in the context of prematurity and its prevention. Efforts should be made to achieve vaginal birth on full term by abandonment of oxytocics and with general cardiotocographic monitoring, despite higher risk of acidosis, however, only in the absence of cephalopelvic disproportionally and grave risk factors. Higher mortality and acidosis risks, accumulation of pulmonary complications, and the need for neonatal intensive care for newborns vaginally delivered from breech presentation were all found by more detailed analysis to be concentrated in the period just before the 35th week of pregnancy. In cases of premature births from breech presentation which could not be therapeutically prevented, caesarean section should be performed up to the 35th week of pregnancy. Vaginal delivery of newborns from breech presentation is considered acceptable beyond the 35th week of pregnancy, with due consideration to be given to the selection criteria generally valid for births on term.

Breech Presentation↗
PubMed1990

[Results of mostly vaginal deliveries of breech presentation].

This report presents results of a retrospective study of infants delivered by the breech, which were according the attitude of this hospital mainly delivered vaginally. This mode of delivery was chosen for primiparae as well as for multiparae and independent of the fetal size measured by ultrasound. Indication for primary caesarean section was seen in only 45 cases out of 568 infants in breech situation. In most of these cases additional indications so as bleedings, placental insufficiency etc, were responsible for the decision of primary caesarean section. Breech presentations are associated to specialties during pregnancy and labour although being more often not related to breech presentation of the fetus as this study shows. Difficulties of spontaneous breech delivered infants were seen rarely. Within the reported cases were 5 of elevated arms, 2 with difficulties in developing the arms and 3 with difficulties in developing the after coming head. Indication for secondary caesarean section were mainly caused by standstill within delivery because of relative disproportion, imminent intrauterine hypoxia and cord prolapse being more often associated to breech presentation. Most important for the possibility of spontaneous breech delivery is the coming deeper of breech during expulsive period. The well known fact of increased number of congenital malformations and anomalies associated to breech presentation were also described in this study. The comparison of the Apgar scores of infants being delivered vaginally or by caesarean section did not show any negative influence of the vaginal mode. This results are independent of different birth weight groups. Therefore there is no evidence to support the recommendation to increase caesarean section rate. Cases of neonatal death--only 13 out of 568 breech infants are discussed casuistically. As a conclusion the authors are confirmed in their conservative attitude and they think the endeavour of spontaneous delivery of breech presentation is justified in all cases unless there are additional indications for caesarean section.

Adolescent↗
PubMed1999

Long-term follow-up of cognitive outcome after breech presentation at birth.

Studies of long-term consequences of birth in breech presentation are sparse. Therefore, we conducted a cohort study linking birth registry data with data collected during evaluation for military service in 4,298 conscripts born between 1973 and 1976. The cognitive functions were measured with the Boerge Prien IQ test. A total of 164 conscripts were born in breech presentation and 70 (42.7%) of these were delivered after Caesarean section. The mean Boerge Prien test score was 43.2 among men born in cephalic presentation and 39.9 among those born in breech presentation for a difference of 3.3 (95% confidence interval = 1.8-4.7). The negative association between breech presentation and cognitive outcome persisted after stratifying by Caesarean section and after adjustment for confounders. It also persisted when we restricted the analyses to term singleton pregnancies.

Adolescent↗
PubMed2006

Women's and providers' experiences of breech presentation in Jamaica: a qualitative study.

BACKGROUND: Most research on breech relates to medical management of the malpresentation. Little is known about women's or providers' experiences of breech, an obstetrical complication. OBJECTIVES: This study aims to increase the understanding of women's and providers' experiences of breech presentation and to understand the effects of context on these experiences. METHODS: A qualitative descriptive research was conducted in a rural health district of Jamaica. Nine postpartum women who birthed singleton live born breech infants in the past year and five experienced obstetric care providers consented to participate. Content analysis was conducted with data from one-time interviews, observations, and hand searches of maternity ward delivery logs. Member checking was conducted with successive participants and Jamaican health care providers. RESULTS: Findings included realizing the baby was breech, interpreting what breech meant, reacting to breech presentation, and identifying the impact of breech. Rates of breech births were less than 1%. CONCLUSIONS: Symbolic interaction can guide nursing and midwifery education, practice and research of breech presentation. Nurses and midwives can identify and teach women and their significant others about breech and its risks.

Adolescent↗
PubMed1985

Spontaneous cephalic version of breech presentation in the last trimester.

A prospective longitudinal investigation of spontaneous cephalic version from breech presentation in the last trimester is reported. All pregnancies were assessed with ultrasound in the 32nd week of gestation, and were thereafter checked weekly. Of the 310 singleton breech presentations identified at 32 weeks, spontaneous cephalic version occurred in 177 (57%) while breech presentation persisted in 133 patients (43%). Of 140 patients with a breech presentation at delivery 95% were already presenting by the breech in the 32nd week. Spontaneous cephalic version was less likely in pregnancies with extended fetal legs, low birth-weight, short umbilical cord and primiparity.

Adult↗
PubMedDate not supplied

Nuchal cord position in breech presentation: case report.

Nuchal cord position in breech presentation has been previously reported and classified into two types. We report a case of breech presentation with nuchal cord. Prenatal ultrasound showed a single nuchal cord inserted into the placenta located on the mid-posterior uterine wall at the level of the fetal neck. Elective cesarean section was performed at 37 weeks. We discuss the clinical significance of nuchat cord.

Adult↗
PubMed1994

[Breech presentation--classification and nomenclature].

In Norway the nomenclature used for the various types of breech presentation differs. In this paper the authors describe the common types of breech presentation and the nomenclature used in the Norwegian textbooks in obstetrics. Using different nomenclature can lead to misinterpretation of the different types of breech presentation which could influence the choice method of delivery. The authors propose an unambiguousness Norwegian nomenclature for the most common types of breech presentation.

Breech Presentation↗
PubMed2004

Antepartum identification of breech presentation.

OBJECTIVE: To determine the accuracy of clinical identification of breech presentation during third-trimester prenatal care and to evaluate factors associated with the accuracy of this determination. STUDY DESIGN: Three hundred eleven patients in the third trimester were prospectively studied. Clinical determination of fetal presentation was made, after which ultrasound was used to determine the true presentation. Amniotic fluid volume, maternal abdominal wall thickness and body mass index were determined for each patient. RESULTS: Among the 311 patients, there were 49 with breech presentation. Twenty-eight of 49 were identified correctly (57.1%). Multiple regression analysis indicated that gestational age, body mass index and maternal abdominal skin thickness did not influence the incidence of correct assessments. There was a significant difference between examiners in the accuracy of clinical assessment of fetal presentation. CONCLUSION: The accuracy of assessment of breech presentation does not appear to depend on gestational age or maternal body mass index but depends more on the individual obstetric care provider.

Abdomen↗
PubMed1988

Uterine activity in spontaneous labour with breech presentation.

Uterine activity was quantified for patients who had a breech presentation, spontaneous labour and a vaginal delivery. Results were studied according to parity and in relation to cervical dilatation. The multiparas with breech presentation overall had lower uterine activity compared to nulliparas when the whole labour was considered. These values were compared with control patients with vertex presentation who had spontaneous normal labour and vaginal delivery. The median uterine activity values in breech presentation were not significantly different from control nulliparous or multiparous patients. Among the breech deliveries, irrespective of parity, mean Apgar scores at 1 and 5 minutes were over 6 and cord arterial blood pH values were above 7.15, but these results were significantly lower than the control cases with vertex presentation. The uterus performs similar uterine activity in spontaneous normal labour whether the fetus presents as a vertex or breech, when controlled for parity.

Breech Presentation↗
PubMed2000

Significance of success rate of external cephalic versions and vaginal breech deliveries in counseling women with breech presentation at term.

OBJECTIVE: To appreciate the role of success rates of external cephalic versions and breech deliveries, in order to assess the risk reduction in women with breech presentation at term. STUDY DESIGN: We reviewed the patient files of all women with breech presentation whom had an attempt of external cephalic version (ECV) at term. Most of the ECVs were performed under intravenous ritodrine infusion. All women had a trial of labor (TOL) as long as they did not meet one or more of the exclusion criteria of vaginal delivery. Success rates of ECV and TOL were assessed, and statistical analysis was performed by using the student t-test for continuous data, and the Chi-square and Fisher's exact tests for categorical data. Statistically significant differences required a P value of <0.05. RESULTS: Of all women with breech presentation at term and not in labor, who had no contraindication for an ECV, 164 consented and were included in the study. The success rate of ECV was 30% (22/74) and 67% (60/90) for nulliparae and multiparae, respectively. Multiparity was the only significant positive predicting variable for ECV success (OR=4.73, 95% CI 4.19-5.27, P=0.00001). Of all the women that underwent a successful ECV, 18/22 primiparae (82%), and 52/60 multiparae (87%) had a vaginal delivery, compared to only 52% of the primiparae and 63% of the multiparae that reached labor with a breech presentation. There were no significant perinatal complications except for one case of mild placental abruption. In the primiparous women, ECV decreased the chance of cesarean delivery by only 9% (P=0.2), compared to a 16% decrease in the multiparae (P=0.019). CONCLUSIONS: When counseling women with breech presentation at term, complete information is needed for consent, and should take into account the success rate of ECVs and of vaginal breech deliveries in the specific center.

Breech Presentation↗
PubMed2006

Outcomes of external cephalic version and breech presentation at term, an audit of deliveries at a Sydney tertiary obstetric hospital, 1997-2004.

BACKGROUND: Probabilistic information on outcomes of breech presentation is important for clinical decision-making. We aim to quantify adverse maternal and fetal outcomes of breech presentation at term. METHODS: We conducted an audit of 1,070 women with a term, singleton breech presentation who were classified as eligible or ineligible for external cephalic version or diagnosed in labor at a tertiary obstetric hospital in Australia, 1997-2004. Maternal, delivery and perinatal outcomes were assessed and frequency of events quantified. RESULTS: Five hundred and sixty (52%) women were eligible and 170 (16%) were ineligible for external cephalic version, 211 (20%) women were diagnosed in labor and 134 (12%) were unclassifiable. Seventy-one percent of eligible women had an external cephalic version, with a 39% success rate. Adverse outcomes of breech presentation at term were rare: immediate delivery for prelabor rupture of membranes (1.3%), nuchal cord (9.3%), cord prolapse (0.4%), and fetal death (0.3%); and did not differ by clinical classification. Women who had an external cephalic version had a reduced risk of onset-of-labor within 24 h (RR 0.25; 95%CI 0.08, 0.82) compared with women eligible for but who did not have an external cephalic version. Women diagnosed with breech in labor had the highest rates of emergency cesarean section (64%), cord prolapse (1.4%) and poorest infant outcomes. CONCLUSIONS: Adverse maternal and fetal outcomes of breech presentation at term are rare and there was no increased risk of complications after external cephalic version. Findings provide important data to quantify the frequency of adverse outcomes that will help facilitate informed decision-making and ensure optimal management of breech presentation.

Adult↗
PubMed1995

Management of term breech presentation: a protocol of external cephalic version and selective trial of labor.

OBJECTIVE: The results of a program of external version and selective trial of labor for term breech presentation are reviewed. This is a follow-up to our 1987 report describing management of singleton, term breech presentations and expands our 16-year experience to 1180 cases. STUDY DESIGN: All term breech presentations cared for in 1985 through 1992 are reviewed and outcome contrasted with those predicted in our earlier report. During these 8 years a trial of external version was offered if a breech presentation was identified after 36 completed weeks' gestation and before active labor. The criteria for allowing a trial of labor are detailed. RESULTS: Four hundred sixty-four breech presentations were identified for review. Three hundred eighty-two (82%) were diagnosed before active labor. Of these, 344 (90%) underwent an attempt at external version, of which 174 (51%) were successful. The 290 breech presentations where version either was not attempted or was unsuccessful were stratified into three groups: cesarean section without labor (147), trial of labor with cesarean section (90), and trial of labor with vaginal delivery (53). The 174 cases where version was successful were stratified into two additional groups on the basis of the eventual route of delivery. Careful review of maternal and fetal variables indicates that a trial of labor in selected patients resulted in vaginal delivery in only 37% but was achieved without an increase in fetal or maternal mortality or morbidity. Surprisingly, 54 of the 174 cases where version was successful were ultimately delivered by cesarean section. This 31% rate of cesarean delivery is significantly higher than the 15% rate observed for all cases of term, singleton vertex presentation. A higher prevalence of cases complicated by failed progress in labor and failed induction contributed to the excess. CONCLUSION: External version is successful in 51% of cases of term breech presentation. With careful selection, cases where version has failed can be allowed to labor and be delivered vaginally. The incidence of cesarean section (31%) for those cases where version had been successful was surprisingly high, largely because of an increase in labor abnormalities and failed labor inductions.

Breech Presentation↗