The dilemma of vaginal breech delivery worldwide

Abstract

The number of caesarean sections being done is increasing worldwide, with an increase in associated complications such as major haemorrhage, sepsis, organ injury, and re-operations at short term, and abnormal placentation with subsequent haemorrhage, obstetric hysterectomy, and uterine scar rupture in subsequent pregnancies. 1 Grivell RM Dodd JM Short- and long-term outcomes after cesarean section. Expert Rev Obstet Gynecol. 2011; 6: 205-215 Crossref Scopus (33) Google Scholar Risks for these and even more serious complications such as maternal death are disproportionally higher in resource-poor settings than in resource-rich settings, leading to huge human suffering. Many doubtful reasons for caesarean sections are reported in the scientific literature, such as reduced amniotic fluid, big babies, premature rupture of membranes, twins, obstructed labour with intact fetal membranes, and a fetus in breech presentation. 2 Maaløe N Sorensen BL Onesmo R Secher NJ Bygbjerg IC Prolonged labour as an indication for emergency caesarean section: a quality assurance analysis by criterion-based audit at two Tanzanian rural hospitals. BJOG. 2012; 119: 605-613 Crossref PubMed Scopus (45) Google Scholar The dilemma of vaginal breech delivery worldwideWe wish to remark on a Comment by Jos van Roosmalen and Tarek Meguid (May 31, p 1863).1 The authors lament the decrease of vaginal breech delivery and express that despite much critique of the Term Breech Trial, caesarean breech delivery practice has been extensively used.2 The Comment presents a sorrowful picture of the unintended results of this practice change, with reported increases in maternal complications and mortality. More than a decade after the Term Breech Trial and its policy implementation, the way forward might no longer be the return of vaginal breech delivery. Full-Text PDF The dilemma of vaginal breech delivery worldwide – Authors' replyWe thank the correspondents for their remarks on our Comment.1 We agree that external cephalic version (ECV) should be done for all suitable women with breech presentation. Unfortunately, ECV is seldom done in sub-Saharan Africa and in many other parts of the world. ECV should, however, be part of obstetric training, but even when ECV is practised, vaginal breech delivery will still result from the many failed ECVs. We do not agree that a failed ECV is an indication for an elective caesarean section. Full-Text PDF The dilemma of vaginal breech delivery worldwideJos van Roosmalen and Tarek Meguid have discussed the decrease of vaginal breech delivery in contemporary obstetric practice in their Comment.1 The publication of the Term Breech Trial2 in 2000 has undoubtedly been associated with an almost complete elimination of breech presentations from delivery suites in the developed world. Our group has previously reported, however, that the practice of vaginal breech delivery was already decreasing prior to publication of the Term Breech Trial and that the trial's findings simply accelerated that trend. Full-Text PDF