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PubMed1997

Perinatal mortality and route of delivery in term breech presentations.

OBJECTIVE: To compare intrapartum related infant mortality in term (> 34 weeks) breech presentations in relation to vaginal delivery or delivery by caesarean section. DESIGN: Register based nationwide study. SETTING: Sweden from 1991 to 1992. PARTICIPANTS: 6542 singleton fetuses born in the breech presentation. MAIN OUTCOME MEASURES: Intrapartum and early neonatal deaths, stillbirths and congenital malformations, low Apgar score < 7 at 5 min, mode of delivery. RESULTS: After exclusion of antepartum stillbirths and congenital malformation, the intrapartum and early neonatal mortality rate was 2/2248 (0.09%) in the group delivered vaginally and 2/4029 (0.05%) in the group delivered by caesarean section. The relative risk was 1.81 (95% CI 0.26-12.84). Thus the difference was not statistically significant. This result was further supported after reviewing individual cases. CONCLUSIONS: The intrapartum related mortality in the group delivered vaginally was low and the result could not verify an increased mortality in term breech presentations delivered vaginally compared with those delivered by caesarean section.

Apgar Score↗
PubMed2007

Evaluation of a decision aid for women with breech presentation at term: a randomised controlled trial [ISRCTN14570598].

OBJECTIVES: To evaluate the effectiveness of a decision aid for women with a breech presentation compared with usual care. DESIGN: Randomised controlled trial. SETTING: Tertiary obstetric hospitals offering external cephalic version (ECV). POPULATION: Women with a singleton pregnancy were diagnosed antenatally with a breech presentation at term, and were clinically eligible for ECV. METHODS: Women were randomised to either receive a decision aid about the management options for breech presentation in addition to usual care or to receive usual care only with standard counselling from their usual pregnancy care provider. The decision aid comprised a 24-page booklet supplemented by a 30-minute audio-CD and worksheet that was designed for women to take home and review with a partner. MAIN OUTCOME MEASURES: Decisional conflict (uncertainty), knowledge, anxiety and satisfaction with decision making, and were assessed using self-administered questionnaires. RESULTS: Compared with usual care, women reviewing the decision aid experienced significantly lower decisional conflict (mean difference -8.92; 95% CI -13.18, -4.66) and increased knowledge (mean difference 8.40; 95% CI 3.10, 13.71), were more likely to feel that they had enough information to make a decision (RR 1.30; 95% CI 1.14, 1.47), had no increase in anxiety and reported greater satisfaction with decision making and overall experience of pregnancy and childbirth. In contrast, 19% of women in the usual care group reported they would have made a different decision about their care. CONCLUSIONS: A decision aid is an effective and acceptable tool for pregnant women that provides an important adjunct to standard counselling for the management of breech presentation.

Adolescent↗
PubMed2002

[Breech presentation in obstetrics in Germany--an assessment of current status].

Nowadays, the CS seems to be the most favourite way of delivery in case of breech presentation. Our opinion is that the vaginal delivery has no disadvantage for the physical and mental development of the newborns [11, 12]. The outcome depends on the set-up and organisation of each department. The most important condition to reach a good outcome by breech presentation is a well-established practical training of the whole team, a careful risk selection and a well structured perinatal centre. In our opinion the CS is the second choice to deliver a pregnant woman with a breech presentation at term. High CS-rates as well as a increased perinatal morbidity at vaginal breech delivery are a sign for insufficient training of the staff and insufficient organisation in small departments not being perinatal centres. Not the breech presentation is the real risk factor, but the unqualified Obstetrician and the insufficient set-up in the most of OB/Gyn-departments. We have a very high ethic responsibility against young women resultating from our profession. It's our duty to decide and recommend the best way to save the wellbeing of the mother and the unborn child. It's also our duty to avoid surgical manoeuvers resulting from economic reasons. Therefore a complete, sufficient practical training concerning breech delivery technics is absolutely needed. In future the answer of the question: "Delivery of breech presentation--vaginally or through CS?" will depend on, if we will be able to change this politic and professional undesirable trend.

Breech Presentation↗
PubMed1997

Evaluation of a protocol for selecting fetuses in breech presentation for vaginal delivery or cesarean section.

OBJECTIVE: Our purpose was to evaluate, with respect to obstetric intervention and neonatal outcome, a protocol for selecting fetuses in breech presentation for vaginal delivery or cesarean section. STUDY DESIGN: A clinical follow-up study was performed between 1984 and 1992 of all term singleton deliveries in breech presentation. Each case selected for vaginal delivery had a matched control in vertex presentation. RESULTS: A total of 1212 infants presented as breech. Vaginal delivery increased from 45% to 57% (p = 0.004), and cesarean section for failure of vaginal delivery declined from 21% to 6% (p < 0.00001). None, however, died or had long-term sequelae because of a complicated or failed vaginal breech delivery. A total of 8.8% of those delivered vaginally in breech versus 5.0% of those in vertex presentation were admitted to the neonatal intensive care unit (p = 0.009). Among those with vaginal delivery, 2.5% in breech presentation were given the clinical diagnosis of birth asphyxia versus none in the vertex position (p = 0.0001). CONCLUSION: Breech presentation at term may be selected for vaginal delivery if properly managed.

Apgar Score↗
PubMed1996

[Delivery from breech presentation with the delivery chair. Initial experiences with a new obstetric method].

OBJECTIVE: To prove safety and practicability of birth from breech presentation on a delivery chair. METHOD: In a retrospective study (1990-1995) all fetuses with breech presentation and those born using a delivery chair were collected. RESULTS: Out of a total of 2,925 fetuses 138 (4.7%) had breech presentation; 82 of them were born on a delivery chair. CONCLUSIONS: Since 1992 all fetuses with breech presentation were born on the delivery chair. The frequency of cesarean sections was roughly the same in both collectives (25.5%). We could not identify any disadvantages with this new technique.

Adult↗
PubMed1991

[The correlations of dysplastic hip joint pathology with fetal breech presentation].

In the article are discussed the causes of hip joint instability at breech presentation. In the article are presented the results of examination of 116 probands with hip joint dysplasia, aged 5-15 years, and 69 breech presentation born probands, It has been carried out genetic-correlative analysis on the basis of population frequency and frequency among the probands' relatives, differentiated in accordance with the signs discussed. The principal cause of the hip joint dysplastic pathology formation at breech presentation is the mechanical factor.

Adolescent↗
PubMed1995

Management of breech presentation: the 1993 Israeli census.

OBJECTIVES: To investigate current attitudes to management of labor and delivery in pregnancies complicated by breech presentation. STUDY DESIGN: A questionnaire was sent to the directors of 23 units of maternal-fetal medicine, all members of the Israel Society of Perinatal Obstetricians. The survey included 69,072 deliveries in the year 1993. Current world literature on the topics included in the survey was also reviewed. RESULTS: The overall response rate was 83% (19/23). The overall breech presentation rate was 3.4%, and overall caesarean section rate was 11.2%. In breech presentation, the caesarean section rate was 63.6%. CONCLUSIONS: A rational approach allows vaginal breech delivery to be practiced in almost half of carefully selected cases. These results again emphasize the longstanding need for prospective randomized studies regarding the different aspects associated with the delivery of the fetus in breech presentation.

Breech Presentation↗
PubMed1987

[Placental implantation as the cause of breech presentation].

The ultrasonographic study of 5294 singleton pregnancies between the 16 and 41 gestational weeks and 47 breech presentations at term revealed the following: The placenta was found in the mid-anterior or mid-posterior region of the uterus in 60.9 to 74.0%. In 12.8 to 18.7% of cases, the placenta was implanted in the fundal region before gestational week 28, but thereafter it was found in the cornual region in 13.8 to 19.1%. Of 47 cases with breech presentation at term, the placenta was implanted in the cornual region in 28, in the fundus in 7, in the lateral in 6, and in the mid-anterior or mid-posterior in another 6. In gestational weeks from 16 to 19, the breech presentation was found in 38% when the placenta was implanted in the cornual region, in 50% when it was implanted in the lateral region, 52.8% in the fundus, and 47.2% in the middle, with no significant difference in the incidence of occurrence. However in gestational weeks from 36 to 41, the incidence was 20.2, 6.4, 9.0 and 1.1% respectively and the spontaneous version rate was significantly higher when the placenta was implanted in the middle region than in others (p less than 0.01). The author has concluded that the breech presentation in single pregnancy is caused by the placental position; when it markedly indents and changes the inverted pear shape of the amniotic cavity, the spontaneous fetal cephalic version is inhibited.(ABSTRACT TRUNCATED AT 250 WORDS)

Breech Presentation↗
PubMed1988

[The mode of delivery and neonatal outcome in breech presentations less than 32 weeks' of gestation].

This study was undertaken to determine the effect of the delivery method on neonatal outcome in fetal breech presentation, and the following results were obtained. The rate of cesarean section for breech presentations was 70.7% (104/147). 1) There were 18 neonatal deaths (41.9%) in 43 vaginal breech deliveries compared to 8 (7.7%) in 104 cesarean breech deliveries. Neonatal deaths were significantly higher in vaginal breech deliveries than cesarean breech deliveries (p less than 0.001). 2) In breech presentations, intracranial hemorrhages were more common among vaginally born infants (44.2% vs. 25.0%; p less than 0.02), but the incidence of idiopathic respiratory distress syndrome (39.5% vs. 28.8%) did not differ significantly between vaginal and cesarean infants. 3) In singletons delivered vaginally, fetal distress was more common among breech presentations than vertex presentations (83.3% vs. 46.3%; p less than 0.02). 4) In vaginally delivered breech singletons, there was no neonatal death among infants with more than 4 one minute Apgar scores, and there was no significant difference between neonatal death and the no neonatal death groups with regard to gestational weeks and birth weight.

Breech Presentation↗
PubMed2005

Assisted vaginal delivery versus caesarean section in breech presentation.

BACKGROUND: The Term Breech Trial (TBT), a well-known study conducted by Hannah and published in the Lancet, revealed a better outcome for neonates after primary caesarean section compared with attempted vaginal delivery. The aim of the present study was to determine whether the results of TBT have to be taken into account when counseling pregnant women in central Europe. METHODS: We investigated 882 women who had delivered infants in breech presentation over a period of 11 years. The neonates had a birthweight of >2500 g and no malformations. We compared mortality and serious neonatal morbidity after attempted vaginal delivery and after primary caesarean section. RESULTS: No infant or maternal mortality was registered in either group. Serious neonatal morbidity was higher (0.5%; n = 2) for attempted vaginal delivery than for primary caesarean section; in the latter group, no child fulfilled the criteria for serious neonatal morbidity. However, the difference was not statistically significant. As expected, after attempted vaginal delivery, the base excess, and 5-min APGAR scores were indicative of more markedly depressed children. CONCLUSION: After careful exclusion of risk factors and informing the patient in detail about the risks and possible complications, vaginal delivery from breech presentation is still warrantable.

Adult↗
PubMed1992

Breech presentation and shoulder dystocia in childbirth.

This review covers the recent literature relevant to breech presentation and shoulder dystocia. Further evidence in favor of external cephalic version at term has emerged, and the possibility of its use in women with previous cesarean section has been suggested. Attention has been given to trial of labor in selected cases of term breech presentation. The evidence to guide the method of delivery for preterm breech presentations remains inadequate. No perinatal differences have been demonstrated among the outcome of breech second-born twins delivered by external cephalic version, breech extraction, or cesarean section. The evidence in favor of elective cesarean for suspected macrosomia to prevent shoulder dystocia is unconvincing for nondiabetics and is doubtful for pregnant diabetics. The McRoberts maneuver for shoulder dystocia has not received the prominence that it deserves.

Breech Presentation↗
PubMed1998

Undetected breech presentation: impact on external version and cesarean rates.

The objective of this study was to determine the impact of undetected breech presentation on an external cephalic version program. We performed a retrospective analysis of all external cephalic versions attempted over a 1-year interval. We then analyzed all cesarean operations performed for the indication of breech presentation over the same interval. Cases involving twin gestations and premature births were excluded. We found that 21% of term breech presentations were not detected before the onset of labor and an additional 15% were not detected until after 38 weeks' gestation. Increased third-trimester screening for breech presentation could potentially decrease the need for cesarean delivery.

Breech Presentation↗
PubMed2005

A randomised controlled trial of moxibustion for breech presentation.

OBJECTIVES: To evaluate the efficacy of moxibustion for the correction of fetal breech presentation in a non-Chinese population. DESIGN: Single-blind randomised controlled trial (RCT). SETTING: Six obstetric departments in Italy. SAMPLE: Healthy non-Chinese nulliparous pregnant women at 32-33 weeks + 3 days of gestational age with the fetus in breech presentation. METHODS: Random assignment to treatment or observation. Treatment consisted of moxibustion (stimulation with heat from a stick of Artemisia vulgaris) at the BL 67 acupuncture point (Zhiyin) for one or two weeks. Two weeks after recruitment, each participant was subjected to an ultrasonic examination of the fetal presentation. MAIN OUTCOME MEASURE: Number of participants with cephalic presentation in the 35th week. RESULTS: The study was interrupted when 123 participants had been recruited (46% of the planned sample). Intermediate data monitoring revealed a high number of treatment interruptions. At this point no difference was found in cephalic presentation in the 35th week (treatment group: 22/65, 34%; control group: 21/58, 36%; RR 0.95; 99% CI 0.59-1.5). CONCLUSIONS: The results underline the methodological problems evaluating of a traditional treatment transferred from a different cultural context. They do not support either the effectiveness or the ineffectiveness of moxibustion in correcting fetal breech presentation.

Adult↗
PubMedDate not supplied

Breech presentations in a sample of Colombian hospitals.

All the breech presentations that occurred in a large sample of data on obstetric deliveries from a random sample of urban hospitals in Colombia are examined. The 463 breeches are analyzed by age and parity of the mother, type of breech presentation (frank or footling) and type of delivery (vaginal or abdominal). The data suggest that abdominal delivery reduces perinatal mortality although cell values are too small to adequately control for birth weight.

Adolescent↗
PubMed2004

Protocol for the evaluation of a decision aid for women with a breech-presenting baby [ISRCTN14570598].

BACKGROUND: There is now good evidence about the management options for pregnant women with a breech presentation (buttocks or feet rather than head-first) at term; external cephalic version (ECV) - the turning of a breech baby to a head-down position and/or planned caesarean section (CS). Each of these options has benefits and risks and the relative importance of these vary for each woman, subject to her personal values and preferences, a situation where a decision aid may be helpful.Decision aids are designed to assist patients and their doctors in making informed decisions using information that is unbiased and based on high quality research evidence. Decision aids are non-directive in the sense that they do not aim to steer the user towards any one option, but rather to support decision making which is informed and consistent with personal values.The ECV decision aid was developed using the Ottawa Decision Support Framework, including a systematic review of the evidence about the benefits and risks of the options for breech pregnancy. It comprises an audiotape with a supplementary booklet and worksheet, a format that can be taken home and discussed with a partner. This project aims to evaluate the ECV decision aid for women with a breech presenting baby in late pregnancy. STUDY DESIGN: We aim to evaluate the effectiveness of the decision aid compared with usual care in a randomised controlled trial in maternity hospitals that offer ECV. The study group will receive the decision aid in addition to usual care and the control group will receive standard information on management options for breech presentation from their usual pregnancy care provider. Approximately 184 women with a single breech-presenting baby at greater than 34 weeks gestation and who are clinically eligible for ECV will be recruited for the trial.The primary outcomes of the study are knowledge, decisional conflict, anxiety and satisfaction with decision-making that will be assessed using self-administered questionnaires. The decision aid is not intended to influence either the uptake of either ECV or planned CS, however we will monitor health service utilisation rates and maternal and perinatal outcomes.

Journal Article↗
PubMed2006

Development and pilot-testing of a decision aid for women with a breech-presenting baby.

OBJECTIVE: To develop a decision aid for pregnant women with a breech presentation at term, and to assess its acceptability. METHODS: The external cephalic version (ECV) decision aid was developed using the Ottawa Decision Support Framework and a systematic review of the evidence to provide probabilistic information about the benefits and risks of options. It incorporates a workbook supplemented by a CD and worksheet, and these were evaluated in a pilot study using self-administered questionnaires. PARTICIPANTS: 19 women with a breech presentation attending antenatal clinics at a local obstetric hospital and 11 recently pregnant women. FINDINGS: Of 30 women surveyed, nearly all found the decision aid clear and easy to understand, and thought that enough information was provided for them to make a decision. Women experienced increased knowledge, reduced decisional conflict, increased satisfaction and participation in decision making without increased anxiety. Participants also found the tool helpful and would recommend it to others. KEY CONCLUSIONS: The ECV decision aid was well accepted and helpful for pregnant women with a breech presenting baby. We are currently evaluating the decision aid in a randomised trial to assess cognitive, affective and health outcomes.

Adult↗
PubMed1978

Cesarean section in the management of breech presentation.

In a retrospective analysis of 275 consecutive deliveries of singleton infants in a breech presentation, the liberal use of cesarean section (58.2 per cent) resulted in a corrected perinatal mortality rate of zero for both vaginal and abdominal deliveries of infants weighing over 2,500 grams although perinatal morbidity was greater for vaginal deliveries (5.6 per cent) compared to cesarean section (0.8 per cent). Comparison of perinatal morbidity for delivery of infants weighing between 1,000 and 2,500 grams in a breech presentation suggests that cesarean section is the method of choice for delivery of infants in this weight range in a breech presentation.

Apgar Score↗
PubMed2005

[External cephalic version of breech presentation at term].

BACKGROUND: External cephalic version could be an alternative to either vaginal delivery or caesarean section in breech presentation at term. MATERIAL AND METHODS: A systematic literature review about external cephalic version in breech presentation. RESULTS: The numbers of breech presentation delivered by caesarean section could probably be reduced in Norway by offering version, but this would not affect perinatal mortality.

Breech Presentation↗