Selective management of breech presentation in mature infants

Abstract

SummaryOf 953 patients with mature fetuses presenting by the breech, 691 (73 per cent) were allowed to labour on clinical considerations supplemented by radiological pelvimetry and ultrasound fetal weight estimation. Eighty-one per cent of these patients delivered vaginally. Rates of epidural analgesia and continuous fetal heart rate monitoring were high; prompt recourse was made to caesarean section where indicated, breech extraction was avoided and application of forceps to the aftercoming head was frequent. Five perinatal deaths occurred in this group, errors in management contributing to four deaths; among the survivors perinatal morbidity was no greater than in those delivered by elective caesarean section. Where labour was terminated by emergency caesarean section, perinatal outcome was no worse than among infants delivered by elective caesarean section, although the mothers had a higher incidence of both blood transfusion and infection.