Cesarean section as the method of choice in management of breech delivery

Abstract

Cesarean section may be the method of choice in management of breech delivery, depending upon a wide range of indications, most of which are relative rather than absolute. Certain of these indications are predicated upon disproportion between the fetus and the birth canal while others are not.In general it may be stated that any significant complication of pregnancy or labor which would constitute an indication for cesarean section in the interests of a fetus in the usual cephalic type of presentation is equally or more valid as an indication for section if the fetus presents as a breech.In the multipara delivery of the breech by cesarean section becomes the method of choice if the patient has lost one or more previous infants by pelvic delivery, or if she has been subjected to one or more previous cesarean sections.Regardless of parity cesarean section may be the only way to secure the birth of a living child for the patient whose pelvis is obstructed by cysts, tumors, or congenital anomalies of the pelvic organs. Under such circumstances the indication for operation is absolute unless the obstruction can be displaced or removed.In the primigravida the age of the patient, if 35 years or over, particularly if associated with a long history of marital infertility, may be in itself an adequate indication for section.An estimate that the fetus in utero is of an appreciably larger size than normal, especially if the patient is primigravid and the fetus postmature, may be a proper indication for abdominal delivery even though the pelvis is believed adequate in its diameters for passage of a normal-sized infant. In the occasional multipara with mild pelvic contraction who has been delivered successfully of one or more small infants through the pelvis the estimate of an oversized fetus in the present pregnancy may make section the method of choice.Experience indicates that in over seven-tenths of our cesarean sections for delivery of the uncomplicated breech in primiparas anticipated fetopelvic disproportion was the crucial factor in causing selection of abdominal delivery. Our experience also indicates that x-ray pelvimetry and pelvic evaluation together with careful clinical measurement of the outlet diameters afford a better guide for prognosticating fetopelvic disproportion than clinical pelvimetry alone.