Breech Presentation In Labour Research Articles

Hemi-diaphragmatic paralysis

Introduction: Diaphragmatic paralysis (DP) involving the phrenic nerve is related to brachial plexus injury in 80–90% of the cases. Other causes include iatrogenic procedure involving the cardiopulmonary area. It causes respiratory distress which can be severe requiring prolonged need for respiratory support. Recovery can be spontaneous, typically by the first 6–12 months of life though some infants may require surgical intervention if no improvement in DP is noted by 1–2 months of life in the setting of compromised quality of life. Case Report: We present a preterm infant, 31 completed weeks of gestational age, birth weight 1440 g born via emergency C-section due to preterm labor in breech presentation. During delivery, the patient suffered a left brachial plexus injury with phrenic nerve involvement. He developed respiratory distress requiring endotracheal intubation and mechanical ventilation. His clinical course involved multiple failed extubation attempts. Chest X-ray (CXR) and chest fluoroscopy confirmed the diagnosis of left hemi-diaphragmatic paralysis. The patient had a prolonged respiratory support course but was finally weaned to room air by three months of age. Conclusion: Preterm infants can sustain perinatal brachial plexus injury like term or near-term infants in the setting of a traumatic birth irrespective of birth weight. The time and indications for conservative (non-surgical) versus surgical intervention remains debatable. Each case should be tailored to the child’s severity of injury and quality of life and growth. Clinical recovery can occur even with considerable persistence weakness on radiography or chest ultrasound.

Pulmonary Hypertension in Pregnancy: A Case Report

Background: Pulmonary Hypertension (PH) is a disease characterized by distressing symptoms and decreased life expectancy due to the narrowing of the blood vessels of the lungs, which often leads to right heart failure. The prevalence of PH in women is 97 cases per million, with 64% of the main causes of PH in pregnancy congenital heart defects, resulting in a very high maternal and fetal mortality rate. Case Report: A 38-year-old G4P1A2 31-week gestational age complained of shortness of breath for 5 days. Physical examination revealed blood pressure was 107/62 mmHg, Heart Rate was 98 beats per minute, respiration 40x per minute, and SpO2 88% with NRM 10 Lpm. The heart examination obtained heart sound I -II regular and a systolic murmur was heard between the left 2nd ribs. Abdominal examination was single fetus, intrauterine, breech presentation, His (+), fetal heart rate 160 beats per minute. vaginal toucher 2 cm in labour. ultrasound examination singles fetal, transverse lies, with an estimated fetal weight of 1600 grams. Echocardiography finding: ASD II L to R shunt with LV EF 60%(T), 62% (S), dilated RA-RV, TR severe, MR mild, High Probability of Pulmonary Hypertension. The patient was diagnosed with Dyspnea, Pulmonary edema caused by cardiogenic, ASD II, High probability of PH, NYHA IV, and Breech presentation in labor. Decided to perform a caesarian section and sterilization. The Male baby was born with 1570 grams Apgar Score 3-5-7. post operation patient was admitted to ICU. Twelve hours after the operation the patient had decreased control and became a PH crisis then the patient was declared dead. Results: The death of the patient, in this case, was caused by cardiogenic shock due to Pulmonary Hypertension Crisis. Conclusion: Early diagnosis along with collaborative and comprehensive management of pulmonary hypertension is needed for good maternal and fetal outcomes. Keywords: pulmonary hypertension, pregnancy, heart disease. Correspondence: Trisulo Wasyanto. Department of Cardiology and Vascular Medicine, Faculty of Medicine, Sebelas Maret University / Dr. Moewardi Hospital. Jl. Kol. Sutarto 132, Surakarta 57126, Central Java, Indonesia. Email: trisulo.wasyanto@staff.uns.ac.id. Mobile: +62811294225.

An Intrauterine Complete Perineal Tear in a Female Neonate, A Rare Birth Injury Related to Breech Presentation: A Case Report

Birth injuries are wounds that a newborn receives when being delivered, whether vaginally or via lower segment caesarean section. It is a case of a 39-week pregnant female with foetal distress and breech presentation in labour who was received in the emergency labour room as a referral case after multiple per vaginal examinations done by a staff nurse at a peripheral hospital, with a complaint of leaking and bleeding per vaginum since then. Her emergency LSCS was done in view of foetal distress with breech presentation. A female baby was extracted and found to have a complete perineal tear in an otherwise healthy neonate. Her paediatric surgeon's opinion wassought, and a complete perineal tear was done in layers with Vicryl 3-0 sutures. On follow-up, the female neonate was continent and thriving well. Unintended vaginal examinations during breech presentation could result in an intrauterine complete perineal tear if the examiner is untrained. If these injuries are identified immediately and prompt management is done, it may lead to lesser morbidity and a better quality of life.

Impact of point-of-care ultrasound and routine third trimester ultrasound on undiagnosed breech presentation and perinatal outcomes: An observational multicentre cohort study.

Accurate knowledge of fetal presentation at term is vital for optimal antenatal and intrapartum care. The primary objective was to compare the impact of routine third trimester ultrasound or point-of-care ultrasound (POCUS) with standard antenatal care, on the incidence of overall and proportion of all term breech presentations that were undiagnosed at term, and on the related adverse perinatal outcomes. This was a retrospective multicentre cohort study where we included data from St. George's (SGH) and Norfolk and Norwich University Hospitals (NNUH). Pregnancies were grouped according to whether they received routine third trimester scan (SGH) or POCUS (NNUH). Women with multiple pregnancy, preterm birth prior to 37 weeks, congenital abnormality, and those undergoing planned cesarean section for breech presentation were excluded. Undiagnosed breech presentation was defined as follows: (a) women presenting in labour or with ruptured membranes at term subsequently discovered to have a breech presentation; and (b) women attending for induction of labour at term found to have a breech presentation before induction. The primary outcome was the proportion of all term breech presentations that were undiagnosed. The secondary outcomes included mode of birth, gestational age at birth, birth weight, incidence of emergency cesarean section, and the following neonatal adverse outcomes: Apgar score <7 at 5 minutes, unexpected neonatal unit (NNU) admission, hypoxic ischemic encephalopathy (HIE), and perinatal mortality (including stillbirths and early neonatal deaths). We employed a Bayesian approach using informative priors from a previous similar study; updating their estimates (prior) with our own data (likelihood). The association of undiagnosed breech presentation at birth with adverse perinatal outcomes was analyzed with Bayesian log-binomial regression models. All analyses were conducted using R for Statistical Software (v.4.2.0). Before and after the implementation of routine third trimester scan or POCUS, there were 16,777 and 7,351 births in SGH and 5,119 and 4,575 in NNUH, respectively. The rate of breech presentation in labour was consistent across all groups (3% to 4%). In the SGH cohort, the percentage of all term breech presentations that were undiagnosed was 14.2% (82/578) before (years 2016 to 2020) and 2.8% (7/251) after (year 2020 to 2021) the implementation of universal screening (p < 0.001). Similarly, in the NNUH cohort, the percentage of all term breech presentations that were undiagnosed was 16.2% (27/167) before (year 2015) and 3.5% (5/142) after (year 2020 to 2021) the implementation of universal POCUS screening (p < 0.001). Bayesian regression analysis with informative priors showed that the rate of undiagnosed breech was 71% lower after the implementation of universal ultrasound (RR, 0.29; 95% CrI 0.20, 0.38) with a posterior probability greater than 99.9%. Among the pregnancies with breech presentation, there was also a very high probability (>99.9%) of reduced rate of low Apgar score (<7) at 5 minutes by 77% (RR, 0.23; 95% CrI 0.14, 0.38). There was moderate to high probability (posterior probability: 89.5% and 85.1%, respectively) of a reduction of HIE (RR, 0.32; 95% CrI 0.0.05, 1.77) and extended perinatal mortality rates (RR, 0.21; 95% CrI 0.01, 3.00). Using informative priors, the proportion of all term breech presentations that were undiagnosed was 69% lower after the initiation of universal POCUS (RR, 0.31; 95% CrI 0.21, 0.45) with a posterior probability greater of 99.9%. There was also a very high probability (99.5%) of a reduced rate of low Apgar score (<7) at 5 minutes by 40% (RR, 0.60; 95% CrI 0.39, 0.88). We do not have reliable data on number of facility-based ultrasound scans via the standard antenatal referral pathway or external cephalic versions (ECVs) performed during the study period. In our study, we observed that both a policy of routine facility-based third trimester ultrasound or POCUS are associated with a reduction in the proportion of term breech presentations that were undiagnosed, with an improvement in neonatal outcomes. The findings from our study support the policy of third trimester ultrasound scan for fetal presentation. Future studies should focus on exploring the cost-effectiveness of POCUS for fetal presentation.

Fetomaternal Outcomes of Breech Presentation in Labour

The purpose of our study was to determine the Fetomaternal outcomes of breech presentations in labour at term. The study was carried out in department of obstetrics and gynaecology, Hayatabad medical complex, MTI, Peshawar. This study included 140 women presenting with breech presentations at term in labour. They were watched for progress of labour and allowed to deliver vaginally or through caesarean section if required. Both vaginal deliveries and caesarean sections were performed by trained medical officers have experience of more than 3 years in teaching hospital. APGAR score of the newborns was noted at 1 &amp; 5 minutes by an accompanied consultant pediatrician having at least 3 years of experience. All the data was collected on a proforma. Maternal outcomes were classified as Breech vaginal delivery or emergency caesarean section. APGAR scores of the neonates at 1 and then 5 minutes interval was used for neonatal outcome. Results showed vaginal breech delivery in 70% women while 30% women had caesarean sections. The APGAR score of majority of babies i.e. 93% was &gt;7 while 7% of babies were born with APGAR score of &lt;7.

SPINAL ANAESTHESIA USING TAYLOR’S APPROACH SAVES THE DAY IN OBESE PARTURIENT.

Subarachnoid block is commonly employed for caesarean deliveries, by virtue of its simplicity in terms of performance, safety for the parturients as compared to general anesthesia. The case history of a 27-yearold female parturiant patient is presented. She was posted for emergency lower segment caesarean section in view of primigravida with breech presentation in labour . She was obese with bodyweight of 102 kg. She had a thick scaly plaque over the back in midline from L1 to L5 area, which is contraindication for administration of spinal anaesthesia via standard median and paramedian approach . Taylor’s approach for administration of the same was tried and proved successful, thus saving the patient from receiving general anaesthesia .

The Birth of first JIPMER “ICSI” Baby

Assisted reproductive techniques are becoming more and more essential for human life in the Society. Worldwide more than 5 million babies were born out of this technology after the birth of first baby Louis Brown and second Durga (India) in 1978. It is a boon for the couple in despair to have a child especially when it is provided by Govt Institutions for the less affordable people of the Society. It is essential to share provider’s experiences and expectations of the public in a fast growing biomedical field like ART. The techniques of IVF and ICSI have undergone a sea change since the initial technique of natural cycles to ovarian hyper stimulation and stem cell research. A 29 year old lady, Type I Diabetic with hirsutism, PCOS, failed IUI underwent ICSI following ovarian stimulation employing antagonist protocol after 8 years of married life. The husband is also diabetic for 13 years and suffered from post-polio residual paralysis and had asthenospermia. Frozen Embryo transfer of cleavage stage embryos was done on 31.7.2019 after endometrial preparation employing HRT. Her β HCG was HCG 387 on 14.8.2019 and intrauterine pregnancy was confirmed by transvaginal scan. Pregnancy and Diabetes were managed with progesterone support and Insulin therapy respectively. An alive male baby was delivered by emergency Caesarean section on 28.3.2020 at 12.34 PM for breech presentation in labour during lockdown for COVID 19. Both mother and baby were discharged home in healthy condition and the baby is one year old at the time of writing this report.

Outcomes of a Breech Birth Program in Canada, Quality Assurance Project.

To report antenatal, intrapartum, and postnatal factors associated with breech birth from our Breech Program at South Health Campus, Calgary. We reviewed all maternal and neonatal patient records where breech birth was documented from 2013 to 2018. Neonatal blood gas values, Apgar scores, birth weight, admissions to NICU, antenatal ultrasound reports, inpatient electronic medical records, and operative and delivery reports, were reviewed. Any indices known as indications, contraindications, or outcomes associated with breech birth were recorded and summarized. Among the 499 breech births that occurred over the study period, there were109 attempted external cephalic versions, 411 planned and 39 unplanned cesarean deliveries, and 49 vaginal deliveries. Unplanned cesarean delivery was performed for newly diagnosed breech presentation in labour (14), footling presentation in labour (9), abnormal fetal heart rate (4), labour dystocia (8), ultrasound findings of low fluid (2) or unfavourable fetal position (1), and worsening maternal hypertension (1). Despite the absence of reported contraindications in the majority of patients and the presence of a program that supported vaginal breech delivery, cesarean delivery was more common. Mothers who chose to labour were highly successful in achieving vaginal birth with excellent maternal and neonatal outcomes.

Anaesthetic management of obstetric and nonobstetric emergencies during pregnancy

Background: Obstetric anaesthesia is considered to be one of the higher risk areas of anesthetic practice. The present study is done to know the various anesthetic techniques in management of obstetric emergencies and their complications. Materials & Methods: This was a descriptive study of 100 pregnant patients coming for emergency surgeries. Intraoperative complications such as hypotension, bradycardia, failed spinal, high spinal, seizures, difficult intubation and aspiration were recorded. Results: 78% of the obstetric emergencies were lower segment caesarean section, 16% was surgery for ectopic pregnancy, 3% hysterectomy for postpartum hemorrhage, 1% bartholin cyst excision, 1% I and D and 1% cervical encirclage. 90% of caesarean sections received subarachnoid block. 8% of cases received general anaesthesia and 2% of case subarachnoid block was converted to general anesthesia. 17 cases previous caesarean section in labour, in 13 cases thick meconium stained liquor with foetal distress, in 6 cases failure to progress, in 5 cases cephalopelvic disproportion, in 5 cases premature rupture of membranes and in 4 cases breech presentation in labour. Hypotension was present in 20 cases, bradycardia in 2 cases and failed spinal in 2 cases. Conclusion: Authors concluded that single shot subarachnoid block is the most common method of anaesthesia for emergency caesarean sections. Chickenpox is a worldwide disease and is no respecter race or class. The incidence increases in spring & winter months in the temperate zones. In the tropics, the peak incidence is during winter and early spring. The disease in fact started is helping the virus to spread rapidly.

Should midwives learn to scan for presentation? Findings from a large survey of midwives in the UK

Background Undiagnosed breech presentation in labour is associated with fetal morbidity and mortality, and may cause significant maternal anxiety. With increasing availability of scan machines, ultrasound is now widely used in UK maternity settings. Bedside presentation scans are usually undertaken by junior doctors, often leading to delays and frustration among staff and patients. Aims To assess local practices and attitudes towards midwives scanning for presentation. Methods A nine-question anonymous online survey was first disseminated by email locally, and then via social media. It was open to all UK non-sonographer midwives and midwifery students. A total of 870 responses were received between January and April 2018. Findings The survey highlighted significant variation in practice across the UK. Of those who did not scan for presentation, 85.2% felt that being able to do so would improve their practice, with the majority of respondents highlighting improvements in patient safety and satisfaction as well as workflow. Conclusions This demonstrates that demand exists for a postgraduate or accredited short course to teach midwives how to safely and accurately scan to assess fetal presentation.

Screening for breech presentation using universal late-pregnancy ultrasonography: A prospective cohort study and cost effectiveness analysis.

BackgroundDespite the relative ease with which breech presentation can be identified through ultrasound screening, the assessment of foetal presentation at term is often based on clinical examination only. Due to limitations in this approach, many women present in labour with an undiagnosed breech presentation, with increased risk of foetal morbidity and mortality. This study sought to determine the cost effectiveness of universal ultrasound scanning for breech presentation near term (36 weeks of gestational age [wkGA]) in nulliparous women.Methods and findingsThe Pregnancy Outcome Prediction (POP) study was a prospective cohort study between January 14, 2008 and July 31, 2012, including 3,879 nulliparous women who attended for a research screening ultrasound examination at 36 wkGA. Foetal presentation was assessed and compared for the groups with and without a clinically indicated ultrasound. Where breech presentation was detected, an external cephalic version (ECV) was routinely offered. If the ECV was unsuccessful or not performed, the women were offered either planned cesarean section at 39 weeks or attempted vaginal breech delivery. To compare the likelihood of different mode of deliveries and associated long-term health outcomes for universal ultrasound to current practice, a probabilistic economic simulation model was constructed. Parameter values were obtained from the POP study, and costs were mainly obtained from the English National Health Service (NHS). One hundred seventy-nine out of 3,879 women (4.6%) were diagnosed with breech presentation at 36 weeks. For most women (96), there had been no prior suspicion of noncephalic presentation. ECV was attempted for 84 (46.9%) women and was successful in 12 (success rate: 14.3%). Overall, 19 of the 179 women delivered vaginally (10.6%), 110 delivered by elective cesarean section (ELCS) (61.5%) and 50 delivered by emergency cesarean section (EMCS) (27.9%). There were no women with undiagnosed breech presentation in labour in the entire cohort. On average, 40 scans were needed per detection of a previously undiagnosed breech presentation. The economic analysis indicated that, compared to current practice, universal late-pregnancy ultrasound would identify around 14,826 otherwise undiagnosed breech presentations across England annually. It would also reduce EMCS and vaginal breech deliveries by 0.7 and 1.0 percentage points, respectively: around 4,196 and 6,061 deliveries across England annually. Universal ultrasound would also prevent 7.89 neonatal mortalities annually. The strategy would be cost effective if foetal presentation could be assessed for £19.80 or less per woman. Limitations to this study included that foetal presentation was revealed to all women and that the health economic analysis may be altered by parity.ConclusionsAccording to our estimates, universal late pregnancy ultrasound in nulliparous women (1) would virtually eliminate undiagnosed breech presentation, (2) would be expected to reduce foetal mortality in breech presentation, and (3) would be cost effective if foetal presentation could be assessed for less than £19.80 per woman.

Evaluation of the effectiveness of transcutaneous nerve stimulation during labor in breech presentation: a case series

Objective: To analyze the effectiveness of pain relief with transcutaneous electrical nerve stimulation (TENS) dispositive during labor in breech vaginal delivery and also to describe its tolerance and satisfaction.Design: A randomized, double-blind, and placebo-controlled trial was conducted.Setting: Labor room of Complejo Hospitalario Universitario Insular-Materno Infantil (Spain).Participants: Ten women who met the inclusion criteria of the clinical trial and also had a fetus breech presentation were randomly assigned to three groups.Interventions: A portable TENS, Cefar Rehab 2pro®, unit was used to apply the experimental intervention, with different doses in the three groups in women during labor. The device intensity (amplitude) was individually adjusted to each participant’s maximum sensory level. The pain was evaluated with visual analog scale (VAS). COMFORTS scale was used to measure women’s satisfaction.Results: A significant association of VAS was detected depending on the type of TENS over time. Active TENS2 was the only group that obtained an improvement with clinically significant results. In connection with women satisfaction, active TENS2 group was also the group that presented higher values.Conclusions: We can recommend the use of TENS dispositive to relieve pain during labor, also in those women with breech presentation.

Comparaison du pronostic obstétrical des tentatives d’accouchement par le siège : travail spontané versus déclenchement

ObjectivesDelivery mode in breech presentation (BP) is often controversial. Spontaneous labor, when vaginal birth seems safe, allows to better estimate uterus contractility, fetus’ accommodation to maternal pelvis and optimize monitoring with a partograph. Induced labor in BP was usually contra-indicated. Lack of strong scientific evidence on this matter has permitted a progressive and careful evolution in obstetrical management, with the introduction of induced labor in BP. The aim of our study is to compare vaginal birth rates when labor is induced versus when spontaneous in BP. Maternal and fetal morbidity and mortality parameters were also evaluated. MethodsIn this retrospective study were included 206 patients carrying fetuses in BP, between June 2012 and June 2017. 182 of them had spontaneous labor and 24 experienced induced labor. Inclusion criteria were singleton pregnancy, BP after 34 weeks of gestation and vaginal delivery authorized by a senior obstetrician. Multiple pregnancy, birth before 34 weeks of gestation, uterine scar, planned caesarian section for BP, intra-uterine fetal death and medical termination of pregnancy were excluded. Induction of labor was performed for medical reason on a favorable cervix. ResultsThere was no significant difference in cesarean section rates between the two “induced” and “spontaneous” labor groups in BP (OR=1.69 [CI95%: 0.71–4.04]). We observed no difference between the two groups in neither perineum trauma nor post-partum hemorrhage. No difference was found between the two groups in rates of Apgar score<7 5minutes after birth, neonatal transfer, fetal trauma and pH at birth. ConclusionDespite our small population, it seems acceptable to propose induced labor for medical reason if cervix is favorable in BP if a protocol is available stating acceptability criteria for vaginal birth. It can avoid unnecessary caesarian section and allow better obstetrical outcome. It would be interesting to study fetal and maternal morbidity and mortality criteria in induced labor versus planned cesarean section when patients could be eligible for induced labor in BP.

Impact of the mode of delivery on maternal and neonatal outcome in spontaneous-onset breech labor at 32+0–36+6 weeks of gestation: A retrospective cohort study

ObjectiveTo compare neonatal and maternal outcomes in spontaneously onset preterm breech deliveries after trial of labor (BTOL) and intended cesarean section (BCS), and between BTOL and vertex control deliveries, in singleton fetuses at 32+0–36+6 weeks of gestation. Study designRetrospective single center cohort study in a Finnish University Hospital including all spontaneous-onset preterm breech deliveries with 32 completed gestational weeks in 2003–2015. The study population comprised a total of 176 preterm breech and 103 vertex control deliveries, matched by gestational age and whether the mother had given birth vaginally before or not. Infants with severe malformations and antepartum fetal distress were excluded. Subgroup analyses were made in two cohorts according to gestational age. Main outcome measures were maternal and neonatal mortality and morbidity, low cord pH and Apgar score. ResultsNo mortality was observed, and severe morbidity was rare. No difference in incidence of low cord pH or five-minute Apgar score was observed between the groups. Apgar scores at the age of one minute were comparable in the breech groups but more often low in the BTOL group compared to the vertex control group. 16.5% of neonates in the BTOL group, 23.3% in the BCS group and 7.8% in the vertex group needed intensive care. In logistic regression analysis, lower gestational age and being small for gestational age were associated with the need for neonatal intensive care. Being allowed a trial of labor was not associated with the need for neonatal intensive care. Maternal morbidity was similar across the groups, but median blood loss was more pronounced in the BCS group compared to the BTOL group. ConclusionIn breech deliveries at 32+0–36+6 gestational weeks, trial of labor did not increase neonatal morbidity compared to intended cesarean delivery. Infants born after a trial of labor in breech presentation display low one-minute Apgar score and need intensive care more often compared to vertex controls.

367: Is induction of labor a reasonable option for breech presentation?

There is good evidence that vaginal delivery of term breech presentation is a safe option in well selected cases. However, regarding induction of labor in breech presentation, international guidelines are inconsistent and its safety is not clearly established. The main objective of this study was to evaluate if induction of labor for women with a breech presentation is a less safe option for infants than planned cesarean delivery. We performed a secondary analysis of the observational prospective multicenter PREMODA study, including all singleton breech deliveries after 37 weeks of gestation in 174 centers in France and Belgium (N=8075). We excluded women with spontaneous labor, scared uterus and intrauterine fetal death. Our study population consisted of women with either an induced labor or a planned cesarean delivery. The primary outcome was the composite criteria of neonatal mortality and serious morbidity used in the Term Breech Trial and in the PREMODA prospective cohort assessing mode of delivery for breech presentations. Our study population consisted of 4138 women, 218 with an induction of labor and 3920 with a planned cesarean. Two-third (67.4%) of the women in the induction of labor group delivered vaginally. There was no significant difference between the two groups for the primary outcome (48 (1.2%) in the planned cesarean group versus 3 (1.4%) in the induction of labor group, p=0.75). None of the criteria of the composite primary outcome was significantly more frequent in the induction of labor group (Table). Induction of labor for breech presentation does not seem to increase neonatal mortality or severe neonatal morbidity compared to a planned cesarean delivery. It appears to be a safe and effective option in the cases of breech presentations with no spontaneous labor and no contraindications to vaginal delivery.

Management of Breech Presentation: Green-top Guideline No. 20b.

Management of Breech Presentation: Green-top Guideline No. 20b.

P237 Undiagnosed breech presentation in labour at term: is it time to consider routine presentation scanning?

P237 Undiagnosed breech presentation in labour at term: is it time to consider routine presentation scanning?

Failed external cephalic version – What do we have to wait for?

The object of external cephalic version (ECV) is to reduce the rate of cesarean sections, especially since the Term Breech Trial and the dramatic reduction in vaginal breech delivery rates. Up to date most of the studies have involved data regarding the chance to succeed in a trial of ECV, and have searched for parameters that may influence this goal. In our center, following a failed ECV, women are told to wait for spontaneous onset of labor, in hope that spontaneous version may occur. Many parturients return with breech presentation in labor and undergo an emergent cesarean section, a procedure involving a significantly higher complication rate compared to an elective cesarean section.

Induction of labor in breech presentation

Objective: Induction of labor in breech presentation, although not contraindicated, has rarely been reported. We have undertaken to evaluate the safety and outcome of this practice in two Israeli institutions along with a literature review of this controversial subject. Method: The research design was a retrospective case control study covering the years: 1980–1999. We have studied 53 term (>37 weeks) breech deliveries induced for various medical and obstetrical reasons, in two major regional hospitals in Israel. Induction was performed with prostaglandin E 2 for the unripe cervix and with oxytocin for induction or augmentation when the cervix was ripe. Six women were induced by nipple stimulation. Controls were 53 women with spontaneous labor in breech presentation that had a trial of vaginal delivery, and 54 women with breech presentation who delivered by elective cesarean section. Result: No significant difference in the various maternal and fetal outcomes was observed. CS rate was comparable in both study and control groups (34% vs. 32%) and two-thirds gave birth vaginally. Conclusions: In properly selected and carefully managed cases of breech presentation, induction of labor seems a safe and reasonable option.

External cephalic version at term with tocolysis and vibroacoustic stimulation

Objective: This study compared the obstetric outcome in women who had external cephalic version (ECV) for breech presentation after 36 weeks gestation with those who did not, to see whether ECV reduces breech deliveries and cesarean section rates with reduced complications. Method: External cephalic version was attempted in 200 women (study group) with the use of tocolysis and vibroacoustic stimulation. The control group (ECV not attempted) comprised of 278 women with breech presentation after 36 weeks. Result: The cesarean section rate was 14.0% in the successful version group compared with 55.2% in the unsuccessful version group. The overall cesarean section rate in the study group was 32.5%. In the control group of 278, the fetus remained in the breech presentation in labor in 269 women with a cesarean section rate of 51.4% which was not different from the unsuccessful version group (55.2%). Conclusion: This study supports the randomized trials conducted earlier in that ECV after 36 weeks gestation reduced the number of breech deliveries and cesarean sections (32.5% in the study group compared with 51.4% in the control group) ( P > 0.00001).