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At least 19 recordsLinked to original sources
PubMed2000

Moxibustion for breech presentation.

Breech presentation at term is considered a possible obstetric complication, and the management before and during labour remains controversial. A technique called 'moxibustion' is used in traditional Chinese medicine to encourage version of the fetus in breech presentation. It has been used in the maternity unit in Plymouth for 11 years. The results would seem to suggest it may have a positive effect and play a part in reducing the number of breech presentations at term and therefore also a reduction in the number of caesarean sections which are so often advocated in breech presentation. This article describes the technique in greater detail and discusses the potential for the future.

Artemisia↗
PubMed2001

Moxibustion treatment of breech presentation.

Breech presentation was successfully corrected by stimulating acupuncture points with moxibustion or low-frequency electrical current. Only patients with breech pregnancies at the 28th week or later were entered into the study. With moxibustion treatment, the control group had a spontaneous correction rate of 165/224 (73.66%), and the treatment group had a correction rate of 123/133 (92.48%) (P<0.0001, x2 test). With low-frequency percutaneous electrical stimulation, the correction rate was 20/941 (83.87%) in the control group and 171/191 (89.52%) in the treatment group (P=0.094, x2 test). The controls in the moxibustion study did no exercises and received no external manipulation to correct breech presentation whereas those in the electrical stimulation study experienced both. Acupuncture stimulation, especially with moxibustion, is expected to serve as a safe and effective modality in the management of breech presentation in a clinical setting.

Acupuncture Points↗
PubMed1996

Intrapartum management of breech presentation.

Breech presentation is associated with significantly increased risk of perinatal morbidity and mortality. Most of the morbidity and mortality associated with breech delivery results from cord compression, nuchal arm, and difficulty in the delivery of the aftercoming head. Routine cesarean delivery of term breeches may not be an unreasonable option, according to many physicians. In our view, the best results for vaginal delivery are achieved using strict protocols that select term or near-term frank breeches of normal size and with proper demonstration of pelvic dimensions. Serious consideration for cesarean delivery should be given to all others. If cesarean delivery is chosen for the very low-birth-weight infant, it is important to use a vertical uterine incision and appropriate anesthesia techniques to ensure atraumatic delivery and optimize out-come. ECV is safe and effective for reducing the incidence of breech presentation but will have little, if any, impact on the overall cesarean delivery rate.

Anesthesia, Obstetrical↗
PubMed2000

External cephalic version facilitation for breech presentation at term.

BACKGROUND: Successful external cephalic version at a late stage of pregnancy was considered to be possible only with the use of tocolytic drugs to relax the uterus. Other methods are also used in an attempt to facilitate external cephalic version at term. OBJECTIVES: The objective of this review was to assess the effects of routine tocolysis, fetal acoustic stimulation, epidural anaesthesia and transabdominal amnioinfusion for external cephalic version at term on successful version and measures of pregnancy outcome. SEARCH STRATEGY: The Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register were searched. Date of last search: February 1999. SELECTION CRITERIA: Randomised and quasi-randomised trials comparing routine versus selective tocolysis; fetal acoustic stimulation in midline fetal spine positions versus dummy or no stimulation; epidural analgesia versus no epidural analgesia; or transabdominal amnioinfusion versus no amnioinfusion for external cephalic version at term. DATA COLLECTION AND ANALYSIS: Eligibility and trial quality were assessed by the reviewer. MAIN RESULTS: Six trials were included. Routine tocolysis was associated with fewer failures of external cephalic version (relative risk 0.77, 95% confidence interval 0.64 to 0.92). There were no significant differences between non-cephalic presentations and caesarean sections. Fetal acoustic stimulation in midline fetal spine positions was associated with fewer failures of external cephalic version at term (relative risk 0.17, 95% confidence interval 0.05 to 0.60). No randomised trials of epidural analgesia or transabdominal amnioinfusion for external cephalic version at term were located. REVIEWER'S CONCLUSIONS: Routine tocolysis appears to reduce the failure rate of external cephalic version at term. Although promising, there is not enough evidence to evaluate the use of fetal acoustic stimulation in midline fetal spine positions. There is not enough evidence to evaluate the use of epidural analgesia or transabdominal amnioinfusion for external cephalic version at term.

Breech Presentation↗
PubMed1988

How perinatologists manage the problem of the presenting breech.

A questionnaire regarding controversies in management of the breech presentation was answered by 405 maternal-fetal medicine subspecialists. Legal concerns strongly influenced clinical management in 63% of respondents. External cephalic version was considered both safe and effective in 90 and 83% of respondents, respectively. Three-quarters of those who responded usually allow a trial of labor in selected term frank breech presentations. Of the respondent subset, 43% usually augment hypotonic contractions with oxytocin. Only 57% agreed there was sufficient literature to favor cesarean section for the 28 to 31 weeks breech presentation, and only 43% so agreed for the 32 to 34 week frank breech. Nevertheless, in these situations, 94 and 83%, respectively, actually perform cesarean section in clinical practice. More than 75% agreed that a prospective study is needed to determine the correct delivery mode of the preterm breech. Ninety-two percent agreed that such data could change their current opinion regarding delivery management. Implications are discussed.

Breech Presentation↗
PubMed1986

Growth in breech presentation. Ultrasound and post-partal assessment of growth in 225 fetuses presenting by the breech in the 33rd gestational week.

225 fetuses with ultrasonically determined gestational age were shown by ultrasound to be in breech presentation in the 33rd gestational week. The biparietal diameter (BPD) and the mean of two perpendicular abdominal diameters (AD) were measured ultrasonically in gestational weeks 33, 35, and 38. Based on these measurements, fetal weight was estimated and compared with weight, length, and head circumference at birth and at 18 months of age. 42% of the fetuses were born in breech presentation (breech group) and 58% in vertex presentation (vertex group). The mean birth weight corrected for gestational age was 4.9% lower in the breech group than in the vertex group, which corresponds to the lower intra-uterine values of BPD and AD found in the breech group. The weight differences at birth still persisted at 18 months of age. There were no differences between the groups regarding head circumference or length, either at birth or at 18 months of age.

Birth Weight↗
PubMed2000

Cephalic version by postural management for breech presentation.

BACKGROUND: It is possible that maternal posture may influence fetal position. Many postural techniques have been used to promote cephalic version. OBJECTIVES: The objective of this review was to assess the effects of postural management of breech presentation on measures of pregnancy outcome. SEARCH STRATEGY: The Cochrane Pregnancy and Childbirth trials register and Controlled Trials Register were searched. Date of last search: February 1999. SELECTION CRITERIA: Randomised and quasi-randomised trials comparing postural management with pelvic elevation for breech presentation, with a control group. DATA COLLECTION AND ANALYSIS: Eligibility and trial quality were assessed by both reviewers. MAIN RESULTS: Three studies involving a total of 192 women were included. Postural management was associated with a non-significant trend towards fewer non-cephalic births (relative risk 0.90, 95% confidence interval 0. 73 to 1.12). No differences were detected for caesarean sections or Apgar scores below seven at one minute. REVIEWER'S CONCLUSIONS: There is not enough evidence to evaluate the use of postural management for breech presentation.

Breech Presentation↗
PubMed1976

[Are more girls than boys born in breech presentation compared with head presentation?].

In breech presentations a little more girls are born than boys, among head presentations there is a slight excess of boys. Among the factors favoring pelvic presentation birth weight has, according to present investigations, a decisive influence on the different sex relationship in the two presentations. Boys are little more common than girls in head presentation in the higher weight groups, in breech presentation in the upper and lower weight groups, while girls predominate in the middle weight groups. The absolute size of the middle weight groups in breech presentation causes the small excess of girls. A possible link with the slightly higher mortality of boys during the first year and its higher incidence in very high and very low weight groups are discussed as well as the dependence of the production of breech presentation on weight and mobility of the fetus.

Birth Weight↗
PubMed1989

[Vertex presentation in the morning--breech presentation at noon: a nursery tale? A prospective study of 1,019 patients].

The percentage of breech presentations in the course of the 32nd to 40th week of gestation is 5.1%; vertex presentations were found in 94.9%. In the primiparae we found 6.0% of breech presentations against 4.3% in the multiparae. Sub partu there were breech presentations in 4.5% (in primiparae more often than in multiparae). A spontaneous change from vertex- into breech presentation from the 32nd to 40th week of gestation was evident in 4 cases = 0.41% [in the primiparae (n = 484) in one case = 0.21%; in the multiparae (n = 531) in 3 cases = 0.59%]. A change from breech presentation (n = 52) into vertex presentation occurred in the same period in 9 cases = 17.31% [in primiparae (n = 29) in 10.34%, in multiparae (n = 23) in 26.09%; the difference is statistically not significant!] All cases of change from vertex- into breech presentation were seen until the 35th week of pregnancy, not later, whereby the cases of change from breech- into vertex presentation happend until the 36th week of pregnancy (except one "late" change in the 39th week in a multipara), in the primiparae until the 36th week, in the multiparae until the 35th week of gestation. Thus, apart from rare exceptions, the definite birth-presentation of the fetus has taken place about the 35th/36th week of gestation. Late changes of position of the fetus are not likely. A diagram with the exact percentages and likelihood of changes of the fetus presentation for primi- and multiparae between 32nd and 40th week of gestation is given.

Birth Weight↗
PubMed2000

[External cephalic version as a possible treatment of breech presentation].

BACKGROUND: Breech presentation shows 3-4% incidence on every foetal presentation at the time of delivery and is more correlated than vertex presentation to a foetal risk of perinatal mortality (with a frequency from 2 to 5 times higher) and to foetal malformations, low weight at birth and prematurity. On the other hand, without a careful case selection, breech delivery has a higher risk of perinatal morbidity and mortality in comparison to cephalic presentation. It is estimated that perinatal mortality for breech presentation at term is about 4-5% for vaginal delivery and about 2-4% for caesarean section. In addition caesarean section has a higher maternal morbidity and a small but significant risk of perinatal mortality, therefore, external cephalic version (ECV) can be a good choice to increase physiological deliveries. The aim of the present study is to evaluate the real efficacy of this obstetric manoeuvre to decrease the frequency of breech presentation at delivery. METHODS: The study group included 67 patients (age 29.5 +/- 3.8) with foetal breech presentation at gestational age 35.8 +/- 1.9 weeks, recruited at the Department of Obstetrics and Gynaecology of the Pavia University. Every patient underwent ECV. The same physician has performed every ECV attempt using the forward roll technique, with previous tocolysis in 50 cases (rithodrine vs isoxsuprine). The following variables have been taken into consideration: amount of amniotic fluid, gestational age, kind of tocolysis, placental location, foetal back position, parity, breech variety and foetal adnexial complication at birth. RESULTS: ECV succeeded in 77.6% (n = 52) and failed in 22.4% (n = 15) of cases. No maternal or foetal complications, side effects and spontaneous breech version occurred and in 74.6% of cases (n = 50) a vaginal delivery was performed. In 25.4% of cases (n = 17) a caesarean section was performed (15 breech presentation, 1 foetal distress in labour and 1 cervical dystocia). Among variables examined related to successful ECV, it has been observed that the amount of amniotic fluid (chi 2 = 15.33; p < 0.0000), the kind of tocolysis (chi 2 = 10.04; p < 0.007) and the umbilical cord rounds (chi 2 = 3.98; p < 0.045) were distributed in a significantly different way, whereas gestational age (p < 0.045) was significantly higher in unsuccessful ECV. CONCLUSIONS: The results obtained suggest that ECV may be a good therapeutic approach for decreasing the percentage of breech presentation at delivery.

Adult↗
PubMed1982

Ultrasonic examination before external version of breech presentation.

35 breech presentations at 35.8 +/- 3.4 weeks of pregnancy (mean +/- SD) were studied by ultrasound immediately before attempting external version. The placenta was located on the anterior wall of the uterine cavity significantly more often in the patients in which external version did not succeed and no spontaneous version occurred (48.6%) than in those in which external version succeeded or spontaneous version to cephalic presentation occurred. The relation of uterine volume to fetal dimensions in the former group was significantly more often smaller than could be expected in relation to the duration of pregnancy. The successful manipulation group included significantly more cases in which the back of the fetus was directed ventrally or dorsally from the maternal midline than did the breech presentations in which version did not occur. The birth weight was also significantly greater in the former group. Our results indicate that ultrasonic examination of the position and size of the fetus, the location of the placenta and the uterine volume is recommended before undertaking an attempt at performing external version of a breech presentation. It is sensible not to attempt this procedure, if the placenta is located on the anterior wall, if the fetus is small and if there is a small ratio between uterine volume and fetal dimensions.

Adult↗
PubMedDate not supplied

[Vaginal delivery in breech presentation does not increase early newborn morbidity. Results of 423 infants with breech presentation 1988-1992].

423 deliveries by breech presentation (1988-1992), delivered by vaginally or abdominally management, were analysed. 72 preterm (32nd to 36th gestational week) and 351 term labours were studied. In 239/423 (56.5%) cases neonates were delivered vaginally, in 54/423 (12.8%) and 130/423 (30.7%) cases primary or secondary cesarean section was necessary. In 120/423 (51.9%) cases of all primaparous spontaneously delivery were realized. There was no difference in early morbidity of vaginal und abdominal delivered neonates (pHNA, APGAR-Score, intracranially bleeding). Three intracranially bleedings (I degrees, II degrees, III degrees) observed in the vaginally delivery group (n = 239), were not the result of breech presentation or vaginally management. No correlation between vaginally management, acidosis and intracranially bleeding were observed. In patients presented with preterm labour (32nd to 36th gestational week) and/or fetal intrauterin growth retardation, cesarean section could be indicated. In postnatal sonographic screening of all neonates hip joint disorders were twice more frequently in female neonates (n = 51 vs. n = 26) without correlation to delivery mode. In conclusion, if certain personally and equipmently conditions are considered, vaginally delivery mode does not correlate to an increase of early neonatal morbidity.

Acidosis↗