The Management of Breech Pregnancies in Australia and New Zealand

Abstract

The Term Breech Trial (TBT), a large-scale international randomized study, concluded that planned cesarean section at term provides the best perinatal outcomes in breech presentations. Most women prefer vaginal delivery,however, and a Cochrane review suggests that external cephalic version (ECV) at term lowers the rates of both noncephalic births and cesarean section. This survey, mailed to all members and fellows of the Royal Australian and New Zealand College of Obstetrics and Gynecology, was an attempt to document current obstetric practice in managing term singleton breech pregnancies. A total of 696 obstetric practitioners responded. Their average age was 49 years and they had practiced obstetrics for 120 years. Most respondents practiced in a tertiary or community/district hospital setting. Before becoming aware of the TBT, 72% of obstetricians had recommended attempted vaginal breech birth, but subsequently only 20% continued to do so. More practitioners with less than 20 years experience stopped recommending vaginal breech birth. ECV was recommended by 67% of obstetricians, and more than 80% performed the procedure themselves. The proportion of practitioners with at least 10 years experience who recommended ECV was significantly lower than those having less experience. ECV is done before 37 weeks gestation by 42% of obstetricians using the procedure. More than half of obstetricians reported using tocolytics for at least some versions. A minority of 28% reported usually doing ECV outside the hospital. Very few respondents ever used analgesia. The median self-estimated success rate for ECV in nulliparous women was 40%, and for multiparous women, 60%. Those using tocolytics reported significantly higher success rates in both nulliparas and multiparas. ECV is an effective approach to breech presentations, but more needs to be learned about why version-and tocolytic agents-are not used more frequently and about the most appropriate timing of the procedure.