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PubMed1979

External cephalic version in breech presentation under tocolysis.

A prospective trial is presented of the benefits and risks of external cephalic version in breech presentation. From January through October 1977, attempts at external version were performed in 53 cases with a success rate of 70%. The version technique is described. Mode of delivery after the maneuver in mothers with breech presentation who for different reasons were not included in the series is reported as well. Both the incidence of breech presentation and the incidence of cesarean section in breech presentation were reduced during the period of study. No serious complications in association with attempts at external version were observed.

Apgar Score↗
PubMed1990

[Breech presentation of the second twin. Effect on early morbidity and perinatal mortality].

Twin delivery is often complicated by breech presentation of the second twin. To investigate the influence of breech presentation of the second twin, we reviewed all 259 twin deliveries from the 18,404 deliveries at our institution over 11 years between 1978 to 1989. The neonatal morbidity of the second twin in breech presentation (pH less than 7,15; 1-minute-Apgar less than 7, transfer to newborn hospital) was significantly higher in comparison to vertex presentation of the second twin. A dependence of neonatal morbidity on the time interval was not found. Where the second twin was in vertex presentation, a higher neonatal morbidity rate with increasing interval was seen. No significant differences were noted for neonatal morbidity between vaginal and caesarean delivery by breech presentation to the second twin.

Apgar Score↗
PubMed1989

Outcome of term breech presentation.

Three hundred and ninety five cases of breech presentation at Harare Maternity Hospital, Harare revealed that caesarean section either electively or in labour resulted in good fetal outcome. Vaginal breech delivery was associated with a perinatal mortality of 74 per 1,000. Fifty four (25%) out of 216 infants delivered vaginally required admission to the Neonatal Unit and thirteen of these had a five minute Apgar Score of 5 or less. Various reasons for this unacceptably high morbidity and mortality are discussed in order to develop a protocol for management of breech presentation in a developing country. The protocol includes the advocation of external cephalic version.

Breech Presentation↗
PubMed1977

[Breech presentations in 1957-1961 and 1967-1975 at the Landesfrauenklinik Magdeburg].

Breech presentation is classed as an abnormality because of the high associated perinatal mortality and morbidity rates and the slightly increased maternal morbidity. A review of 14 years' experience with breech delivery was undertaken to ascertain patterns of care. During this period there were 33 183 births and there were 1271 cases of breech presentation. The method of delivery in the 1271 cases included 91,5 per cent vaginal deliveries and 8,5 per cent cesarean sections. There was an increase to 15,3 per cent during the last 2 years of the review. This review indicates a decline in perinatal mortality rate from 20,3 to 5,4 per cent (unselected). Breech presentation is often associated with premature labor. Premature labor represents the significant clinical problem by contributing to perinatal morbidity and death.

Breech Presentation↗
PubMed2001

Planned vaginal delivery versus elective caesarean section in singleton term breech presentation: a study of 1116 cases.

OBJECTIVE: To compare neonatal and maternal morbidity and mortality between planned vaginal delivery and elective cesarean section for singleton term breech presentation. STUDY DESIGN: We studied retrospectively all deliveries of singleton breech presentations at term in the public Hospitals of Lyon between 1 January 1991 and 31 December 1995. To take only the effect of delivery on the fetus into account, we eliminated high risk pregnancies and fetal malformations. Fetal parameters were corrected perinatal mortality, Apgar score<7 at 1 and 5 min, umbilical cord arterial pH<7.15, neurological disorders, trauma and need for neonatal intensive care. Maternal parameters were mild, moderate and severe complications. RESULTS: Of the 1116 breech presentations, 702 (62.9%) underwent an elective caesarean section and 414 (37.1%) a planned vaginal delivery. In the latter group, 342 (30.6%) had a vaginal delivery and 72 (6.5%) a non-elective caesarean section. Infants for whom the vaginal route was planned were at higher risk of mortality and morbidity. There were 2 deaths in this group and none in the elective caesarean section group and all fetal parameters were poorer: more Apgar<7 at 5 min (RR: relative risk=3.05; 1.03-9.05), arterial pH<7.15 (RR=1.64; 1.11-2.43), intubations (RR=7.35; 2.10-25.6), neurological disorders, trauma (RR=4.24; 1.66-10.8), transfer to intensive care units (RR=3.23; 1.57-6.64). The overall maternal morbidity was lower in the planned vaginal delivery group (RR=0.65; 0.44-0.94) but this was only because of less mild complications. The moderate and severe complications were the same in the two groups (RR=0.97; 0.59-1.57). CONCLUSIONS: Planned vaginal delivery in singleton term breech presentation increases the risk of death and of neonatal complications. Elective caesarean section increases the risk of only mild maternal complications. For these reasons, elective caesarean section should be preferred for singleton term breech presentations.

Adult↗
PubMed2003

[External cephalic version for breech presentation at term: an effective procedure to reduce the caesarean section rate].

AIM: Although term breech presentation is a relatively rare condition (3-5% of all births), it continues to be an important indication for caesarean section and has contributed to its increased use. Risk of complications may be increased for both mother and foetus in such a situation. Vaginal delivery of a breech presenting foetus is complex and may involve many difficulties, so today there is a general consensus that planned caesarean section is better than planned vaginal birth for the foetus in breech presentation at term. External cephalic version is one of the most effective procedures in modern obstetrics. It involves the external manipulation of the foetus from the breech into the cephalic presentation. A successful manoeuvre can decrease costs by avoiding operative deliveries and decreasing maternal morbidity. The aim of the present study is to evaluate the effectiveness of this obstetric manoeuvre to increase the proportion of vertex presentation among foetuses that were formerly in the breech position near term, so as to reduce the caesarean section rate. The safety of the version is also showed. METHODS: From 1999 to 2002, 89 women with foetal breech presentation underwent external cephalic version at the Department of Obstetrics and Gynaecology of the Brescia University. The gestational age was 36.8+/-0.8 weeks. The following variables have been taken into consideration: breech variety, placental location, foetal back position, parity, amount of amniotic fluid and gestational age. Every attempt was performed with a prior use of an intravenous drip of Ritodrine, and foetal heart rate was monitored continuously with cardiotocogram. RESULTS: The success rate of the procedure was 42.7% (n=38). No maternal or foetal complication or side effects occurred, both during and after the manoeuvre, except a transient foetal bradycardia that resolved spontaneously. Only one spontaneous reversion of the foetus occurred before delivery. Of all the women that underwent a successful version, 84.2% (n=32) had a non complicated vaginal delivery. Five women (15.8%) had a caesarean section. There was no significant interaction between the variables assessed. CONCLUSION: The external cephalic version is a safe and effective manoeuvre reducing the risks of vaginal breech delivery and the rate of caesarean section.

Breech Presentation↗
PubMed1985

Perinatal mortality in breech presentations as compared to vertex presentations in singleton pregnancies: an analysis based upon 57819 computer-registered pregnancies in The Netherlands.

In 1982, nationwide registration of obstetric data was instituted in The Netherlands with about 70% of all Dutch hospitals participating. The resultant data from 57819 singleton pregnancies in vertex or breech presentation at delivery was studied. The vertex and breech groups were compared. The proportion of breech presentations relative to vertex presentations was greater in low gestational age infants and those of low birthweight. After correction for gestational age and birthweight, the perinatal mortality was higher in the breech groups than in the vertex groups. Congenital malformations occurred more frequently in the breech group but, even after exclusion of infants with congenital malformations, perinatal mortality remained higher in the breech group at any gestational age. Caesarean section was more frequently performed in the breech group than in the vertex group but did not appear to improve the outcome of breech presentation. It is possible that breech presentation is not coincidental but is a consequence of poor fetal quality, in which case medical intervention is unlikely to reduce the perinatal mortality associated with breech presentation to the level associated with vertex presentation.

Birth Weight↗
PubMed2006

The relation of breech presentation at term to epilepsy in childhood.

OBJECTIVE: To investigate the relation between breech at term and epilepsy in childhood, and identify risk factors for epilepsy in term breech infants. STUDY DESIGN: Register-based study of all (n = 7514) singleton term infants without malformations, born between 1980 and 1994 and hospitalised with epilepsy until year 1996. For each case delivered in breech presentation (n = 290), the two subsequent deliveries of non-malformed, singleton infants delivered in breech presentation at term at the same hospital were selected as controls (n = 580). RESULTS: Breech presentation was a risk factor for epilepsy (OR: 1.2 [95% CI: 1.1, 1.3]). Breech infants with epilepsy were more often small for gestational age (9.7%) than breech infants without epilepsy (4.7%). Vaginal delivery was associated with low Apgar score, but mode of delivery and low Apgar score were not related to epilepsy. CONCLUSION: The increased risk of epilepsy in term breech infants is not related to intrapartum events, but to growth restriction in pregnancy.

Birth Weight↗
PubMed1987

Management of term breech presentation.

The management of 716 cases of singleton breech presentation occurring at 37 or more weeks of gestational age is reviewed. Beginning in 1980 a trial of external version was offered if the breech was identified before active labor. Only 433 (61%) breeches were identified before active labor. Of these, 171 (44%) underwent an attempt at external version and 83 (48%) were successful. The 623 cases remaining as breech presentation were stratified into three groups: cesarean section without labor (379), trial of labor with cesarean section (69), and trial of labor with vaginal delivery (175). The criteria for allowing a trial of labor are detailed. Careful review of maternal and fetal variables indicates that a trial of labor in selected patients will result in vaginal delivery in 72% and that this can be achieved without an increase in fetal or maternal mortality or morbidity. Furthermore, successful external version followed by a trial of labor in selected cases is highly cost-effective.

Breech Presentation↗
PubMed1981

[Frequency of breech presentation during pregnancy and on full term (author's transl)].

The causes underlying the relationship between breech presentation and premature birth were studied, with reference to the premature birth discussion which has assumed sizeable dimensions in the obstetric community. -- An evaluation of 785 ultrasonographic findings from pregnant women has shown breech presentation to be just as frequent as vertex presentation up to the 24th week of pregnancy. The former, consequently, should be considered as physiological. The frequency of breech presentation was found to go down continuously only beyond the 24th week and to drop below five per cent, after the 35th week of pregnancy to reach eventually the figure usually recorded at birth. These observations were found to be in good agreement with what has been reported by other authors. -- The authors of this paper were struck by surprise, when they found that the breech presentation figure, in the context of 997 premature births, was, with high significance, below the level usually recordable from unimplanted pregnancy. -- The above findings are discussed in great detail. Preliminary suggestions are made regarding possible interpretations. Yet, further target-oriented studies are required.

Breech Presentation↗
PubMed1987

Vaginal delivery of the second twin in breech presentation.

The obstetric performance of 39 vertex-breech twin-pairs was compared with that of 48 vertex-vertex pairs. No difference was found between the two groups in maternal age, parity, gestational age, birth weight, and Apgar scores. The second twin in breech presentation had a higher incidence of very low birth-weight (less than 1500 g), but of borderline significance (P = .05), and a significantly (P less than .03) longer hospitalization period. The cesarean section rate was 7.7 and 10.4% for the breech and vertex second twin, respectively. In our view, breech presentation of the second twin is not an indication for cesarean section.

Apgar Score↗
PubMed1989

[A 1-year study of the management of fetal breech presentation by monitoring follow-up during second-stage labor instead of using external version, x-ray pelvimetry and ultrasonic assessment of fetal weight].

The authors studied 246 parturients with breech presentation of the fetus. All women were examined by an obstetric monitor. Cesarean section was performed on 33 women/ = 13.41% of women with breech presentation). Perinatal morbidity and mortality were the same as those of women with vertex presentation. The frequency of cesarean section was 11.98% of multiparas and 31.57% of nulliparas. According to the authors careful observation of advancement of delivery as well as the state of the fetus (by an obstetric monitor) could lead to management of delivery with breech presentation just as that of vertex presentation. This management of breech presentations should reduce the fear of delivery, which is observed in most parturients with breech presentation of the fetus.

Body Weight↗
PubMed2002

Women's attitudes towards management of breech presentation at term.

Current advice on the management of breech presentation at term is that all uncomplicated cases should be offered external cephalic version (ECV) or an elective caesarean section. Clinical experience suggests that ECV is currently not offered as widely as advised and that the majority are delivered electively by caesarean section. We present the results of a patient attitude survey of term breech deliveries in a university teaching hospital over 12 months. The results show that half of respondents were not offered ECV and that two-thirds of these women were not eligible for ECV, either having had a previous caesarean or breech presentation diagnosed in labour. One-third of women, potentially suitable for ECV, were not made aware of their options. The majority are offered elective caesarean section with a small minority (10%) opting for planned vaginal breech delivery.

Attitude to Health↗
PubMed1981

[Perinatal risk of delivery from breech presentation (author's transl)].

Results obtained in the context of deliveries from breech presentation at the Gynaecological Hospital of Berlin-Buch, between 1972 and 1976, have been evaluated.--All patients who delivered by caesarean section were on full term.--Perinatal mortality of all deliveries from breech presentation accounted for 2.27 per cent--The causes of death were listed and showed that perinatal mortality in the context of deliveries from breech presentation could not be reduced by increased application of caesarean section, but it should be achieved primarily by more prevention of prematurity.

Birth Injuries↗
PubMed1993

Breech presentation and fetal growth retardation.

Although it has been consistently demonstrated that breech presentation is associated with fetal growth retardation, this relationship has not been clarified. This study intends to elucidate this association by use of live births recorded in North Carolina in 1988 and 1989. A remarkable difference in birth weight between breech and vertex infants existed only in the preterm births. Although the breech infants had a higher proportion of small for gestational age than the vertex infants, the difference in the proportions decreased with advancing gestational age. Our analysis indicated that breech presentation is unlikely to be a cause of fetal growth retardation. Results of the study also implied that the significant association between breech presentation and increased perinatal mortality may be due in part to the common correlation with premature delivery and fetal growth retardation.

Birth Weight↗
PubMed1982

Singleton breech presentation in labor: experience in 1980.

Excessive perinatal loss is associated with breech presentation, and, in large measure, this loss is accounted for by prematurity, congenital anomalies, and birth trauma. In the endeavor to exert an effect on two of these problems, cesarean section has been resorted to increasingly. Three hundred thirty singleton breech pregnancies were reviewed, and delivery in 74.2% of these was by cesarean section. The only cases in which a trial of labor was routinely allowed were frank breech presentations at term. Fetal compromise during labor and delivery was relatively uncommon and seen to occur at both vaginal delivery and cesarean section. Preventable mortality was limited to infants who weighed less than 1,300 gm. Morbidity was also primarily associated with low birth weight, and was not significantly different in term infants delivered vaginally and those delivered by cesarean section. The conclusion drawn is that a liberal policy toward the use of cesarean section for breech presentation is necessary in conjunction with the manual skills required to effect a safe breech delivery, in order to minimize perinatal loss.

Breech Presentation↗
PubMed1983

Randomized management of the nonfrank breech presentation at term: a preliminary report.

Cesarean section has become the standard management used by many clinicians for breech presentation in labor. Proof of the superiority of routine cesarean section has been largely circumstantial. Concern over rising cesarean section rates has led to renewed interest in possible alternatives. Protocols have been developed to select which patients may be allowed a trial of labor with frank breech presentation at term. We undertook a prospective clinical trial comparing elective cesarean section with a selective management protocol for the nonfrank breech presentation at term. One hundred five patients with nonfrank breech presentations at term in labor were studied. Seventy (67%) were randomized to a trial of labor and 35 (33%) to elective cesarean section. Of the patients allowed a trial of labor, 31 (44%) were delivered vaginally, and 39 (56%) required cesarean section. The largest single cause of a "failed" trial of labor was inadequate pelvic dimensions on x-ray pelvimetry (23 patients, 59%). Neonatal morbidity assessed by Apgar scores, cord gases, birth injury, and hospital stay was not different for those delivered vaginally or by cesarean section. Maternal morbidity in terms of febrile morbidity, blood transfusion, wound infections, and hospital stay was significantly greater among women delivered by cesarean section. Two of three neonatal deaths occurred in infants with major congenital anomalies. The third infant, apparently normal, died after vaginal delivery. Extensive evaluation suggests the death was attributable to inadequate resuscitation. We conclude that the use of a selective management protocol under controlled conditions is a reasonable alternative to elective cesarean section. Approximately one half of patients allowed a trial of labor may be expected to deliver vaginally with neonatal morbidity comparable to that seen with cesarean section.

Adult↗
PubMed1978

The site of placental attachment as a factor in the aetiology of breech presentation.

The frequency of cornu-fundal implantation of the placenta in association with breech presentation was investigated in the following study. In a series of 124 women with breech presentation, and 125 women with cephalic presentation at or near term, the implantation site of the placenta was demonstrated by ultrasonography. It was found that with breech presentation the placenta was implanted in the cornual region in 72.6% of the cases, as compared with 4.8% in cephalic presentation. The placental implantation site may therefore have a determining effect upon the presentation of the foetus.

Breech Presentation↗