[THE CHANGE IN SURGICAL OBSTETRICS THROUGH VACUUM EXTRACTION].
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The single breech deliveries at the Universitäts-Frauenklinik Insbruck from 1973 to 1977 have been reviewed. Related to a total number of 10.693 deliveries 390 children (3.6%) were born in breech presentation. The unselected perinatal mortality rate of infants in breech presentation was 7.0% which is 4 times higher than the total infant mortality (1.6%). This seems to be due to the higher prematurity rate with breech presentation compared to all deliveries (22.6% versus 8%). In 1977 only premature breeches have been lost. The perinatal mortality rate of premature infants with breech presentation is higher than those of premature babies with vertex presentation (26.3% versus 9.8%). Therefore, more care is needed for the prevention of premature labour in breech presentation. The Caesarean section rate because of breech presentation increased from 18% (1973) to 40% (1977); nevertheless the perinatal mortality rate couldn't be reduced. Up to the present we have been afraid of deliver large series of premature breeches by Caesarean section. Maybe that therefore the perinatal mortality rate couldn't be reduced. However, according to our results routinely performed Caesarean section with mature breeches is not justified. In our opinion a decrease of perinatal morbidity and mortality only can be obtained by reducing the premature breeches.
A normotensive pregnant woman who had no historical risk factors for abruption placenta and found to have Breus' mole that indicates the pattern of single or multiple hematoma protrude above the chorionic plate was encountered. The case resembled a large fetal abdominal wall defect coexisting with a singleton live-born fetus at 27 weeks of gestational age is presented. The obstetric ultrasound showed that multiple coiled masses in the amniotic cavity, both the fetus and the placenta were normal. After two courses of tocolysis therapy, a healthy and, 1,400 g live-born infant was delivered through cesarean section due to fetal distress. Apgar scores at 1 and 5 min were 5 and 8, respectively. The infant died on postnatal day 6 due to severe respiratory distress and prematurity. This rare condition probably occurs frequently in missed abortion and the etiology is unknown, but is probably related to circulatory disturbance on maternal site. We report a rare clinical presentation and review the literature of Breus' mole.
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