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PubMed1979

[Catamnestic findings in breech-presentation births].

Connections exist between the delivery technique for breech presentation cases and the intellectual development of infants. Extracted infants show lower development quotients (EQ) than others delivered with a modified Bracht. Diagnostic symptoms of early brain damage are found in either group. No symptom combination appears to have a significant effect on the EQ level. A prospective delivery technique should be selected in the case of breech presentation on the basis of specific criteria.

Brain Damage, Chronic↗
PubMed2002

Mortality and early neonatal morbidity in vaginal and abdominal deliveries in breech presentation.

From January 1984 to June 1986, 268 consecutive breech presentations in two university hospitals were studied prospectively. Vaginal delivery was attempted in all cases, under expert supervision and electronic monitoring, except in the presence of clear-cut contraindications. For most of the examined parameters no statistically significant differences were found in mortality and morbidity between the vaginally delivered group and the caesarean section group in three birth weight categories. Regarding mortality a relation with the mode of delivery was demonstrable in two cases in the vaginal group and one case in the caesarean section group in the low and very low birth weight category. In the 500-1499 g birth weight category, underestimation of the birth weight during pregnancies led to iatrogenic neonatal death in two cases. Our study shows that the management of breech presentation can be modified in order to stop the increase in caesarean section rate and diminish the degree of variation in operative delivery without affecting the perinatal outcome.

Belgium↗
PubMed1997

Intrapartum sonography of the lower uterine segment in patients with breech-presenting fetuses.

Uterine leiomyomas have been associated with an increased incidence of fetal malpresentation. Intrapartum sonographic examination, currently advocated in the assessment of patients with a breech presenting fetus includes assessment of flexion of the fetal head, sonographic estimated fetal weight, and the precise type of breech presentation. Data obtained during this evaluation is utilized in deciding the preferred mode of delivery. We report two cases in which intrapartum sonographic assessment of a women with breech-presenting fetuses at 39 and 40 weeks of gestation depicted large lower uterine segment leiomyomas, which were considered an indication for cesarean. The association between uterine leiomyomas and fetal malpresentation, and our cases support consideration of sonographic scanning of the lower uterine segment in patients being evaluated for vaginal delivery with a breech-presenting fetus.

Adult↗
PubMed1981

[Some present aspects of the problems of breech presentation and delivery (author's transl)].

The author, basing his conclusions on an experience of 491 deliveries and a review of the most recent literature, comes to the conclusion that the problem of breech delivery can be considered thus: It is not properly described as a dystocic delivery, but it is a high risk delivery with an outcome that is always uncertain. The proof of this is that the perinatal mortality swings between 0.5 to 2 or 3% according to different authors. The lesions that cause this mortality and their mechanism are well known. It consists of potential dangers, the realisation of which depends on the conditions and the way in which the deliveries are conducted. As far as treatment is concerned, there is no well established line of conduct but only opinions based on individual experiences. It is only by carrying out a large prospective study that the best way in which breech deliveries should be performed can be worked out.

Adolescent↗
PubMed2004

Breech presenting twin A: is vaginal delivery safe?

The aim of our study was to compare the neonatal outcome of vaginally delivered breech-presenting twins (VD) to those delivered by cesarean (CS). Maternal and neonatal charts of all live, non-anomalous twins delivered at > or =25 weeks of gestation, in a single tertiary care center, over an 11-year period were reviewed. Of 517 twins delivered, 130 breech-presenting twins were analyzed. Thirty-five (26.9%) were delivered vaginally and 95 (73.1%) by cesarean. More patients presented in labor with advanced cervical dilation in the VD compared to the CS group. There was no difference in the incidence of respiratory distress syndrome, intraventricular hemorrhage, need for mechanical ventilation, length of nursery stay or neonatal mortality rate when twin A was compared in the two groups. However, one breech-presenting twin in the VD group had a traumatic delivery at 32 weeks of gestation that caused a spine fracture followed by immediate neonatal death. Although there seems to be no compromise in the immediate neonatal outcome of breech-presenting twins delivered vaginally compared to those delivered by cesarean, the case of head entrapment that led to intrapartum death is quite alarming. Based on our study, we cannot advocate normal vaginal delivery when twin A is non-vertex: cesarean seems to be a safer route of delivery.

Adult↗
PubMed1996

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

Since the late sixties, the question of wether a breech presentation should be delivered vaginally or by caesarean section has been discussed by obstetricians, with special reference to the aim of improving foetal outcome. This review of the literature surveys the ante- and intrapartum considerations and activities which should be carried out in cases of breech presentation. The factors influencing foetal and maternal morbidity and mortality are discussed, and external cephalic version is considered. Based on these considerations and a careful examination of the pregnant woman and her obstetric history, we suggest vaginal delivery in strictly selected breech presentations. Selection criteria are given.

Breech Presentation↗
PubMed1999

The management of breech presentation in the last three decades.

In order to evaluate the changes in management of breech presentation during the last three decades, a retrospective analysis of the "Alexandra" Hospital records was undertaken. The years, 1965, 1975, 1985, 1995 and finally 1997 were used as pilot years for this purpose. The cesarean section, breech presentation and breech cesarean section rates were calculated for each year. Specific breech cesarean section rates in respect to birth weight and parity as well as perinatal mortality rates were also recorded for each pilot year. The overall cesarean section rate rose from 8.0% in 1965 to 25.2% in 1995 and 25.1% in 1997 while the breech cesarean rate climbed from 16.9% in 1965 to 74.1% in 1995 and 72.3% in 1997, irrespective of birth weight. A trend towards vaginal delivery of breeches in multiparous women till 1985 became less apparent in later years. During the same period, a marked decrease of the perinatal mortality rate was observed from 70.1/1000 in 1965 to 36.6/1000 in 1997. In conclusion, a more than four-fold increase of the breech cesarean section rate was apparently rewarded by a two-fold decrease in perinatal mortality.

Breech Presentation↗
PubMed2006

Changes in the rates of caesarean delivery before labour for breech presentation at term in France: 1972-2003.

OBJECTIVE: To describe the changes in the rate of caesarean deliveries before labour among women with term breech presentations in France and to identify the factors associated with this change over two periods: 1972-1995/1998 and 1995/1998-2003. POPULATION: The study population consisted of 1479 women with a foetus in a breech presentation at term and without any previous caesarean delivery, from the population of births in the 1972, 1995, 1998 and 2003 national perinatal surveys (N=53136). Data from the 1995 and 1998 surveys were pooled. METHODS: The principal endpoint was caesarean delivery before labour. Associations between the factors studied and caesarean before labour were estimated by odds ratios, both crude and adjusted with a logistic regression model. RESULTS: Between 1972 and 2003, the rate of caesareans before labour for women with term breech presentations rose sharply (from 14.5% in 1972 to 42.6% in 1995/1998 and to 74.5% in 2003). Between 1972 and 1995/1998, this increase was especially marked among the nulliparous women (16.7% versus 52.9%). From 1995/1998 to 2003, the increase was greatest for multiparas: in 2003 this rate among women with children was close to that for women who had never given birth (64.5% and 79.5%, respectively). After adjustment, the factors associated with a high rate of caesarean before labour were nulliparity, birth between 38 and 40 weeks' gestation, birth weight > or =3800g, delivery in the private sector and year of delivery. The rate of caesareans before labour was significantly higher in 2003 (ORa=19.04 [12.06-30.06]) and in 1995-1998 (ORa=4.30 [2.87-6.47]) than in 1972. CONCLUSION: The increase in the rate of caesarean deliveries before labour in women with term breech presentations was associated principally with changes in obstetrical practices.

Adult↗
PubMed1977

[Preventive version of breech presentation--first results and complications].

In breech presentation near term the prophylactic external cephalic version using tocolytic drugs represents a modern practice. This method needs a critical valuation. Report about 23 external versions with assistance of tocolytic drugs and insufflation anesthesia. In 17 cases the version was successful. In addition to the 3 unsuccessful attempts 3 complications appeared: twice a partial ablatio placentae and once a prolapse of the arm and umbilical cord on intact amniotic sac.

Anesthesia, Inhalation↗
PubMed2004

Breech presentation: increasing maternal choice.

Pregnant women with a third trimester breech presentation are almost invariably offered Caesarean section as the mode of delivery of first choice, especially when external version has failed to turn the fetus to cephalic. However, increasingly women are resorting to alternatives, to avoid either operative delivery or manipulative intervention in late pregnancy. This paper reviews some of the options for women with breech presentation, focusing especially on integrating these options into conventional maternity care.

Adult↗
PubMed1978

[Monitoring and delivery of the premature infant in breech presentation].

We explored 183 deliveries in breech presentation. The birthweights from this offsprings were 1941 +/- 418,1 g. 101 were primiparae. The perinatal mortality of the underweigth fetuses was 5 more higher when delivered vaginally in relation to delivery by caesarean section. These differences were statistically significant (p less than 0,05). In relation to multiparae 71,8% of the offsprings survived when delivered vaginally, in comparison to 79,2% offsprings from primiparae. The APGAR-scores (1 and 5 min. p. p.) less than or equal to 7 or greater than or equal to 8 showed no significant differences by the offsprings delivered vaginally or by caesarean section. The pHNA was higher in the group of children, delivered by means of caesarean section. The conclusions are discussed.

Apgar Score↗
PubMed2004

[Alternative methods instead of external cephalic version in the event of breech presentation. Review of the literature].

Fetal breech presentation at term is more and more treated by a planned cesarean section. Considering the increased maternal morbidity and mortality in relation to abdominal delivery versus vaginal birth, natural and innocuous methods have been proposed for the promotion of a spontaneous fetal cephalic version during the last two Months of pregnancy. In order to stimulate fetal motility many techniques have been described, either advising postural methods (passive bridge, Indian version, knee-chest position) or using acupuncture (stimulation of the fifth toe and auricular points). Other techniques like chiropractic manipulations or hypnosis have also been tried. Unfortunately, most publications are retrospective and methodologically inaccurate, but it seems that their results may be favorably compared with that of the external cephalic version, a much more complex procedure, which is potentially dangerous and certainly time consuming and expensive. The only randomized controlled trial with a proven efficacy concerns moxibustion (burning herbs to stimulate the acupoint BL 67 or Zhiyin, located beside the outer corner of the fifth toenail).

Acupuncture Therapy↗
PubMed2005

Fetal breech presentation predisposes to subsequent development of septic arthritis of the hip.

We postulated a link between breech presentation and septic arthritis of the hip. To examine the potential association between these 2 relatively uncommon entities, we used the Patient Administration Systems and Biostatistics Activity (PASBA) database, which contains coded information derived from hospitalizations and ambulatory encounters at U.S. military hospitals worldwide. Among a cohort of nearly 1 million infants born in a 14-year period, 3.37% were found to be in the breech presentation. The rate of septic arthritis of the hip or pelvis during the first year of life among these breech infants was approximately 1/8000, providing a relative risk of 4.1 (95% confidence interval, <1.4-11.7) compared with the rate among nonbreech infants. Fetal breech presentation predisposes to the development of septic hip during the first year of life.

Arthritis, Infectious↗
PubMed2006

Systematic review of adverse outcomes of external cephalic version and persisting breech presentation at term.

The aim of this study was to determine the frequency of adverse maternal and fetal outcomes of both external cephalic version (ECV) and persisting breech presentation at term. We conducted a systematic review of the literature using Medline, Embase and All Evidence Based Medicine (EBM) Reviews databases. Data were extracted from studies that compared women who had an ECV from 36 weeks' gestation with a similar control group of women enrolled at the same gestational age, eligible for, but who did not have an ECV. Eleven studies with a total of 2503 women were included. Adverse outcomes related to ECV were rarely reported and in most studies there was no evidence that relevant outcomes were ascertained among similar women who did not have an ECV. There was no increased risk of antepartum fetal death associated with ECV, but numbers were small. There were no reported cases of uterine rupture, placental abruption, prelabour rupture of membranes or cord prolapse, but these outcomes were not examined among controls. Onset of labour within 24 h and nuchal cord was non-significantly higher among women who had an ECV compared with those with a persisting breech. Despite limited reporting and small numbers, the results of our review suggest that adverse maternal and fetal outcomes of both ECV and persisting breech presentation are rare. Only with improved reporting and collection of safety data on ECV and persisting breech presentation can we provide high-quality information to assist informed decision making by pregnant women with a breech presentation at term.

Breech Presentation↗
PubMed1990

Pelvimetry by magnetic resonance imaging in breech presentation.

Evaluation of the pelvis by pelvimetry plays an important role in selecting patients with term breech presentation for possible vaginal delivery. X-ray pelvimetry involves the disadvantage of fetal exposure to ionizing radiation. Computed tomography reduces the amount of radiation markedly, but there is still a risk. Ten patients with breech presentation at term underwent antepartum pelvimetry with magnetic resonance imaging, following by postpartum magnetic resonance pelvimetry and x-ray pelvimetry. Measurements with magnetic resonance imaging are as reliable as those obtained with x-ray pelvimetry and the contrast of the magnetic resonance images is even better. The advantages of magnetic resonance pelvimetry are clear: no ionizing radiation and reliable pelvimetry results in cases of term breech presentation in which a normal pelvis is a prerequisite for safe vaginal delivery.

Breech Presentation↗
PubMed2004

Management of breech presentation in areas with high prevalence of HIV infection.

OBJECTIVE: To provide recommendations for the management of breech presentation in areas of high prevalence of human immunodeficiency virus (HIV) infection. METHOD: Review of relevant literature. RESULTS: Studies show that elective cesarean section (CS) is safer than vaginal delivery for breech presentation, external cephalic version (ECV) at term increases the chance of vaginal cephalic delivery. Although there are no studies of the risk of mother-to-child transmission of HIV from ECV, indirect evidence suggests that any increased risk is likely to be very small. RECOMMENDATIONS: Where CS is available and safe, HIV-positive women, or women who might be at risk of HIV, with a fetus at term with breech presentation, should be offered elective CS to reduce the risks of both vaginal breech delivery and mother-to-child HIV infection. HIV-negative women can be offered ECV at term to try to avoid CS. Where women do not have access to a safe CS, or prefer vaginal delivery, the benefit for both mother and child of attempting ECV at term is likely to outweigh the theoretical, very small, risk of facilitating HIV transmission.

Breech Presentation↗