Breech Presentation and Delivery

Breech presentation is associated with altered joint shape and hip dysplasias, but effects on bone mineral content (BMC), area (BA) and density (BMD) are unknown. In the prospective Southampton Women's Survey mother-offspring cohort, whole-body bone outcomes were measured using dual-energy X-ray absorptiometry (DXA) in 1430 offspring, as neonates (mean age 6days, n = 965, 39 with a breech presentation at birth) and/or at age 4.1years (n = 999, 39 breech). Hip and spine bone outcomes were also measured at age 4years. Neonates with breech presentation had 4.2g lower whole-body BMC (95% CI -7.4 to - 0.9g, P = 0.012) and 5.9cm2 lower BA (- 10.8 to - 1.0cm2, P = 0.019), but BMD was similar between groups (mean difference - 0.007, - 0.016 to 0.002g/cm2, P = 0.146) adjusting for sex, maternal smoking, gestational diabetes, mode of delivery, social class, parity, ethnicity, age at scan, birthweight, gestational age and crown-heel length. There were no associations between breech presentation and whole-body outcomes at age 4years, but, in similarly adjusted models, regional DXA (not available in infants) showed that breech presentation was associated with lower hip BMC (- 0.51, - 0.98 to - 0.04g, P = 0.034) and BA (- 0.67, - 1.28 to - 0.07cm2, P = 0.03) but not with BMD (- 0.009, - 0.029 to 0.012g, P = 0.408), or spine outcomes. These results suggest that breech presentation is associated with lower neonatal whole-body BMC and BA, which may relate to altered prenatal loading in babies occupying a breech position; these differences did not persist into later childhood. Modest differences in 4-year hip BMC and BA require further investigation.

In a retrospective analysis, presentation behavior during pregnancy of 501 infants with breech presentation at birth was compared with that of a control population (n = 520) with vertex presentation at birth. Since the fetus usually changes position frequently during the sonographic examination prior to the 20th week of pregnancy, and since its presentation behavior is generally unstable, presentation of the fetus was only determined sonographically from this point onward. In both populations it was found in 40% of the cases that the fetus remained in either breech or vertex presentation up to birth; and in both populations there was one change of position to the definitive presentation at birth in 44% of the cases (before the 33rd week of pregnancy in 95%). Seventeen percent of the infants born from breech presentation and 15% of those born from vertex presentation changed position several times during pregnancy. The stability of presentation behavior during pregnancy of infants with breech presentation at birth was similar to that of infants with vertex presentation. At about the 32nd week of pregnancy, 90% of the fetuses in both breech and vertex presentation had assumed their final presentation prior to birth. Even when breech presentation is found between the 33rd and 36th week of pregnancy there is still a 54% probability of a change to vertex presentation at birth. In contrast, the probability of the fetus turning from vertex to breech presentation at birth in this period of pregnancy is only 0.4%.

Delivery in breech presentation: Perinatal outcome and neurodevelopmental evaluation at 18 months of life

Breech birth at term: vaginal delivery or elective cesarean section? A systematic review of the literature by a Norwegian review team

Using data on hospital deliveries published by the Ministry of Health, trends in fetal mortality in the Kingdom were investigated in this study. The study spanned 1391H through 1405H, corr...

Breech position during pregnancy is associated with reduced range of fetal movement, and with lower limb joint stresses. Breech presentation at birth is associated with lower neonatal bone mineral content (BMC) and area, but it is unknown whether these associations persist into later life. We examined associations between presentation at onset of labor, and tibia and hip bone outcomes at age 17years in 1971 participants (1062 females) from a UK prospective birth cohort that recruited > 15,000 pregnant women in 1991-1992. Cortical BMC, cross-sectional area (CSA) and bone mineral density (BMD), periosteal circumference, and cross-sectional moment of inertia (CSMI) were measured by peripheral quantitative computed tomography (pQCT) at 50% tibia length. Total hip BMC, bone area, BMD, and CSMI were measured by dual-energy X-ray absorptiometry (DXA). In models adjusted for sex, age, maternal education, smoking, parity, and age, singleton/multiple births, breech presentation (n = 102) was associated with lower tibial cortical BMC (- 0.14SD, 95% CI - 0.29 to 0.00), CSA (- 0.12SD, - 0.26 to 0.02), BMD (- 0.16SD, - 0.31 to - 0.01), periosteal circumference (- 0.14SD, - 0.27 to - 0.01), and CSMI (- 0.11SD, - 0.24 to 0.01). In females only, breech presentation was associated with lower hip CSA (- 0.24SD, - 0.43 to 0.00) but not with other hip outcomes. Additional adjustment for potential mediators (delivery method, birthweight, gestational age, childhood motor competence and adolescent height and body composition) did not substantially affect associations with either tibia or hip outcomes. These findings suggest that prenatal skeletal loading may exert long-lasting influences on skeletal size and strength but require replication.

How should preterm singleton babies in breech presentation be delivered?

Breech repositioning unresponsive to Webster technique: coexistence of oligohydramnios

Treatment of Camels Affected with Trypanosoma Soudanense with “Bayer 205,”` and Further Observations on the Formolgel Test

The aim of this study was to evaluate the frequency and type of hip-joint instability and the frequency of hip dislocation requiring treatment in neonates who had been lying in the breech presentation and were delivered vaginally after an external version or by caesarean section, and to compare them with neonates who were naturally in the vertex presentation. Breech presentations without ongoing labour were subjected to an attempted external version and, in cases where this proved unsuccessful or where labour had started, to deliver by caesarean section. None of the breech presentations was vaginally delivered. The anterior-dynamic ultrasound method was used to assess the hip-joint status of the neonates. Out of 6,571 foetuses, 257 were in breech presentation after 36 wk of pregnancy. Sixty-two were vaginally delivered following an external version to vertex presentation and 195 were delivered by caesarean section, 75 of these following unsuccessful attempts to perform a version. Treatment for congenital hip-joint dislocation was performed on 0.2%. Out of the breech presentations, 1.0% of those delivered by caesarean section were treated, while in those with vaginal delivery following an external version the treatment frequency was 3.2%. No case of late diagnosed hip dislocation was recorded. Significant differences in frequency of hip-joint instability and treatment were found between (i) neonates delivered in breech presentation and those delivered with vertex presentation, (ii) infants delivered in vertex presentation, naturally or after successful version, and (iii) those delivered by caesarean section with or without attempted external version and those delivered with vortex presentation. Breech presentation predisposes to increased hip instability. The instability is present prior to delivery and is certainly not a primary result of delivery forces. Both breech and vertex presentations following an external or spontaneous version should be considered as risk factors for neonatal hip instability.

552: Breech presentation at delivery: an indicator of congenital anomaly?

Comparaison de la prise en charge per-partum des présentations podaliques par rapport aux présentations céphaliques

The number of vaginal breech and twin deliveries may be insufficient for adequate training. To determine whether advanced trainees and new Fellows in obstetrics are gaining adequate experience and confidence in vaginal breech and twin deliveries. An online survey was emailed to registered Royal Australia and New Zealand College of Obstetrics and Gynaecology (RANZCOG) advanced trainees and new Fellows (Years 1-5). This survey asked about their experience, confidence and whether they intend to perform vaginal breech and twin deliveries as specialists. The survey was sent to 703 advanced trainees (162) and Fellows (541) and answered by 217 (31.7%). Experience and confidence in vaginal breech and twin deliveries increased with the number of procedures performed (P<0.001) in both groups and were significantly higher among Fellows. Despite the level of experience, 100% of respondents felt confident in managing vaginal twin deliveries with or without supervision, whereas 14.9% of respondents did not feel confident in managing vaginal breech deliveries. Intention to offer these procedures in their practice depended on confidence levels, and there was a significant difference between twins and breech. Overall, 87.3% of respondents intended to offer vaginal twin deliveries in their practice, while only 32.7% intended to offer vaginal breech deliveries. Confidence in complex vaginal deliveries increases with increasing number of procedures performed and a significant proportion of trainees and Fellows consider they do not have sufficient experience. The association between confidence and intention to offer these procedures is stronger in twins than in breech deliveries.

Recent research has demonstrated that the media presentation of childbirth is highly medicalized, often portraying birth as risky and dramatic. Media representation of breech presentation and birth is unexplored in this context. This study aimed to explore the content and tone of news media reports relating to breech presentation and breech birth. Google alerts were created using the terms breech and breech birth in online English-language news sites over a 3-year period from January 1, 2013, to December 31, 2015. Alerts were received daily and filed for analysis, and data were analyzed to generate themes. A total of 138 web-based news reports were gathered from 9 countries. Five themes that arose from the data included the problem of breech presentation, the high drama of vaginal breech birth, the safe option of cesarean birth versus dangers of vaginal breech birth, the defiant mother versus the saintly mother, and vaginal breech birth and medical misadventure. Media reports in this study predominantly demonstrated negative views toward breech presentation and vaginal breech birth. Cesarean birth was portrayed as the safe option for breech birth, while vaginal breech birth was associated with poor outcomes. Media presentations may impact decision making about mode of birth for pregnant women with a breech fetus. Health care providers can play an important role in balancing the media depiction of planned vaginal breech birth by providing nonjudgmental, evidence-based information to such women to facilitate informed decision making for birth.

Now that ultrasonography is a routine examination in pregnancy, breech presentations are frequently diagnosed. On the basis of 4066 individual examinations a graph was drawn indicating the relative frequency of breech, vertex and transverse presentations in the course of pregnancy. There are clear, and in some cases statistically significant differences between primiparae and multiparae with regard to the individual presentations. The analysis of several ultrasonographic examinations of one and the same patient makes a prediction possible of the likelihood of the foetus moving from breech to vertex presentation in a particular week of the pregnancy. Here there are clear differences between primiparae and multiparae: thus, the chance that a foetus in breech presentation in the 29th week will move spontaneously into vertex presentation in a primipara is 31.1%, while the degree of probability in multipara is 70.2%. In the 33rd week the probability is 15.5% in primiparae, as opposed to 57.5% in multiparae. From the 37th week on, spontaneous movement into vertex presentation is no longer likely to occur, in either primiparae or multiparae. In the 29th week, on the other hand, the likelihood of a foetus in vertex presentation moving into breech presentation in a primiparae is 0.6%, while in a multiparae it is considerably higher, at 2.3%. From the 33rd week on there is no likelihood of spontaneous movement into breech presentation in either group. Two tables, for primiparae and multiparae, respectively, show the likelihood of movement from one presentation to the other between the 13th and 41st weeks.(ABSTRACT TRUNCATED AT 250 WORDS)