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Abstract

We welcome the interest expressed by Sheridan et al in our article examining the changes in vaginal breech delivery rates over a 16-year period. They are correct in their observation that our examination of the perinatal mortality rate (PNMR) relates to the whole population and not that of the breech population. As mentioned in the manuscript, the study is a retrospective observation, for which we used hospital annual clinical reports as our main source of data. Because of the nature of our data collection, specific examination of the PNMR of breeches was impossible. It is thus, difficult to speculate as to whether changes in management of breech deliveries has had an impact on PNMR of this patient group or on the institutional rates of PNMR of the 3 hospitals involved in the study. The term breech trial did, however, suggest an improvement in PNMR associated with delivery by elective caesarean section.1Hannah M.E. Hannah W.J. Hewson S.A. Hodnett E.D. Saigal S. Willan A.R. Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial Term Breech Trial Collaborative Group.Lancet. 2000; 356: 1375-1383Abstract Full Text Full Text PDF PubMed Scopus (1527) Google ScholarStandard management of breech presentations at all 3 institutions includes discussion about external cephalic version (ECV) at 37-38 weeks' gestation. ECV is a valuable tool in efforts to decrease incidence of breech presentation.2Royal College of Obstetrics and GynaecologyGreen top guideline no. 20a External cephalic version and reducing the incidence of breech presentation.2010Google Scholar Rates of ECV participation and success rates during the study period were not, however, examined, as the aim of the study was to primarily examine changing practice relating to delivery of breech presentation. Future studies could investigate the implementation of ECV across the Dublin maternity hospitals. We welcome the interest expressed by Sheridan et al in our article examining the changes in vaginal breech delivery rates over a 16-year period. They are correct in their observation that our examination of the perinatal mortality rate (PNMR) relates to the whole population and not that of the breech population. As mentioned in the manuscript, the study is a retrospective observation, for which we used hospital annual clinical reports as our main source of data. Because of the nature of our data collection, specific examination of the PNMR of breeches was impossible. It is thus, difficult to speculate as to whether changes in management of breech deliveries has had an impact on PNMR of this patient group or on the institutional rates of PNMR of the 3 hospitals involved in the study. The term breech trial did, however, suggest an improvement in PNMR associated with delivery by elective caesarean section.1Hannah M.E. Hannah W.J. Hewson S.A. Hodnett E.D. Saigal S. Willan A.R. Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial Term Breech Trial Collaborative Group.Lancet. 2000; 356: 1375-1383Abstract Full Text Full Text PDF PubMed Scopus (1527) Google Scholar Standard management of breech presentations at all 3 institutions includes discussion about external cephalic version (ECV) at 37-38 weeks' gestation. ECV is a valuable tool in efforts to decrease incidence of breech presentation.2Royal College of Obstetrics and GynaecologyGreen top guideline no. 20a External cephalic version and reducing the incidence of breech presentation.2010Google Scholar Rates of ECV participation and success rates during the study period were not, however, examined, as the aim of the study was to primarily examine changing practice relating to delivery of breech presentation. Future studies could investigate the implementation of ECV across the Dublin maternity hospitals. Changes in vaginal breech delivery rates in a single large metropolitan areaAmerican Journal of Obstetrics & GynecologyVol. 207Issue 3PreviewHehir et al1 report a significant decrease in rates of vaginal breech delivery in both nulliparous and multiparous women over a 16-year study period in Dublin, Ireland. They also report a significant decrease in the perinatal mortality rate (PNMR), although this refers to the whole population rather than reporting and comparing the PNMRs of the 11,913 term breech babies with the rest of the population (Table 2). Thus it is impossible to conclude whether the changing management of breech presentation made any contribution at all to the falling overall PNMR. Full-Text PDF