Caesarean Section For Breech Presentation Research Articles

Caesarean Section for Breech Presentation on Scarred Uterus with Giant Fibroid Praevia

Breech presentation at term occurs in 3-4% of the pregnant population. The fibroid is a source of obstetrical complications in pregnant women in 10 to 40% of cases. We describe a case of a Caesarean section for breech presentation on scarred uterus with giant fibroid praevia measuring just 12 cm/10 cm in diameters.

P16 Linear bullous aplasia cutis congenita of the scalp: an unusual presentation of a rare condition

Abstract Aplasia cutis congenita (ACC) is a heterogenous group of congenital disorders characterized by focal or widespread absence of skin. Bullous ACC is a rare variant that presents with well-circumscribed oval lesions resembling bullae or vesicles covered with a thin membrane. There have been 20 previously reported cases of bullous ACC. We present a female neonate referred to dermatology at day 2 of life following an IVF-assisted pregnancy and delivery by elective caesarean section for breech presentation. There was no antenatal history of infection, trauma or drugs, and no relevant family history. Clinical examination of the parietal scalp revealed five well-demarcated bullae in a linear distribution along Blaschko lines. The hair collar and ‘golf club set’ signs were absent. Skin swabs for microbiology and viral studies were negative. Ultrasonography showed no associated osseous defect. Clinical examination was otherwise normal. A diagnosis of multibullous ACC was made, and a conservative approach adopted. Clinical follow up at 2 years found resorption of one bulla with flattening of the remainder. Neurodevelopment was normal. On review of the literature, 10/20 (50%) cases of bullous ACC presented with multiple bullae. The hair collar sign was positive in 50%, strengthening theories that bullous ACC may represent a ‘forme fruste’ of a neural tube defect. Four other cases reported distribution along Blashko lines, suggesting possible underlying cutaneous mosaicism. The majority (90%) had no associated cutaneous or extracutaneous findings. Clinical outcomes were good with spontaneous resorption of bullae, suggesting conservative management is appropriate in most cases.

Planned vaginal delivery versus planned caesarean section for breech presentation at term

Unless favourable conditions are present, breech vaginal deliveries are less commonly performed. The aim of this study was to compare the neonatal outcomes of women with breech fetuses who underwent trial of labor for breech delivery versus women who had a planned caesarean section.

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.

Obstetric fracture of the femur during cesarean section in a preterm baby: A case report

Introduction: Obstetric fractures or Birth fractures are rare events following childbirth. Although fracture of the femur is a relatively uncommon injury, it is the most common fracture of the lower extremity in the newborn. Since evolution of cesarean section rates in Africa, it is one of the most commonly practiced modes of delivery for breech. We described one case of fracture of the femur at cesarean section treated at Adlucem hospital in bonabéri-Douala (Cameroon). Case report: A 2.1 kg male infant was delivered by lower segment cesarean section for breech presentation. Clinical and radiological examination showed shaft fracture of femur with good evolution. Discussion: Fractures of the long bones are associated with cesarean section, breech delivery with assistance and low birth weight. Femoral fractures are the most associated long bones fracture with cesarean section. Conclusion: The clinical and paraclinical diagnosis is simple and the management is mostly non-operative. It is important to explain to the parents and especially to the mother the benignity of the lesion.

Pregnancy following Brown-Séquard syndrome: A rare case report

Brown-Séquard syndrome is an incomplete spinal cord lesion characterized by hemisection injury of the cord. We present a case of pregnancy, delivery and postpartum course following this rare neurological condition. A 42-year-old woman presented with past history of idiopathic hemicord myelitis leading to right sided hemiplegia with decreased contralateral sensation of pain and temperature, consistent with Brown-Séquard syndrome, which was treated with steroids and Therapeutic Plasma Exchange. Thereafter, she had near-complete motor recovery and complete sensory recovery over the next 3months. Three years later, she presented to us at 37+2 weeks of gestation with residual hemiparesis with motor power grade of 4/5 in right upper and lower limbs. She underwent Caesarean section for breech presentation, which was done under general anaesthesia in view of prior spinal cord lesion. She was discharged for follow-up in Neurology outpatient clinic and physical rehabilitation. At follow up after 12 months of delivery, she had complete motor and sensory recovery. Management of spinal cord lesions in pregnancy and delivery requires specialist multidisciplinary care due to risk of medical and obstetric complications. This case demonstrates a rare scenario of a primigravida at term gestation with residual deficits of a past spinal cord lesion.

Success rate of external cephalic version in relation to the woman's body mass index and other factors-a population-based cohort study.

The aim of this study was to evaluate the impact of women's body mass index (BMI) on the probability of a successful external cephalic version (ECV). A retrospective population-based observational study including all women that underwent an ECV in the southeast region of Sweden from January 2014 to December 2019. Data were collected from electronic medical records, Obstetrix, Cerner. The women were divided into BMI categories according to the World Health Organization classification. Women with a BMI below 25kg/m2 formed the reference group. Crude and adjusted odds ratios for unsuccessful ECV in each BMI group were calculated using binary logistic regression. Furthermore, the association between maternal characteristics and clinical and ultrasound variables at the time of the ECV and unsuccessful ECV was evaluated. A total of 2331 women were included. The overall success rate of ECV was 53.4%. Women with a BMI below 25kg/m2 had a success rate of 51.3% whereas obese women had a success rate of 58.6%. The risk of an unsuccessful ECV among obese women (BMI ≥30kg/m2 ) had an OR of 0.74 (95% CI 0.59-0.94) compared with women with a BMI below 25kg/m2 . After adjusting for suitable confounding factors, the association was no longer significant. Higher maternal age, multiparity, higher gestational age, posterior placenta position, polyhydramnios and higher estimated weight of the fetus at the ECV significantly decreased the risk of an unsuccessful ECV. Maternal obesity does not seem to negatively influence the success rate of ECV. This is a finding that may encourage both caregivers and obese pregnant women to consider an ECV and so avoid a planned cesarean section for breech presentation in this group.

OEIS Syndrome: Omphalocele, Exstrophy of the Cloaca, Imperforate Anus, and Spinal Defects

OEIS Syndrome: Omphalocele, Exstrophy of the Cloaca, Imperforate Anus, and Spinal Defects

Leiomyosarcoma in pregnancy: Incidental finding during routine caesarean section

Uterine leiomyosarcoma (LMS) is uncommon tumour arising from the female reproductive tract. Incidence of LMS in pregnancy is extremely rare, with only 10 cases reported thus far in medical literature. We present a case of myomectomy performed during elective caesarean section for breech presentation, due to its easy accessibility and well contracted uterus. Subsequent histology revealed LMS on final specimen. Patient subsequently underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy. No chemotherapy was given as she opted for close clinical- radiological monitoring instead. This case report highlights the importance of discussion with patients regarding the risk of occult malignancy in a fibroid uterus. Appropriate management of uterine leiomyosarcoma in pregnancy remains unclear. Consideration of removing an enlarging leiomyoma during caesarean section might be ideal in view of its malignant potential, just like in this case; however, location of the tumour and risk of bleeding needs to be weighed. Ultimately, management of such cases needs proper discussion between obstetrician and the patient.

A rare case of isolated congenital foot drop in a new-born infant

We report a case of congenital foot drop in a term neonate born through cesarean section for breech presentation. The antenatal history was unremarkable; the baby was born well and no significant anomalies were noted at birth except for right congenital foot drop. The rest of the neurological examination was unremarkable with normal head and spine ultrasound scans. The postnatal period was otherwise unremarkable with normal feeding and examination. Baby was discharged home in stable condition with regular physiotherapy on follow-up. The foot drop completely resolved by 3 months of age with physiotherapy alone. Baby is currently doing well with normal growth and development.

Why not plan an elective Caesarean section for breech presentation at term – safety first?

Why not plan an elective Caesarean section for breech presentation at term – safety first?

Subtrochanteric Femur Fracture in Neonates: A Rare Complication after Breech Presentation

ABSTRACT Fetus born in breech presentation are commonly delivered via cesarean section which is necessary to prevent trauma, and this extraction by operative maneuver can rarely lead to trauma and may result in femur fracture. But delivery of breech via vaginal route leads to various complications such as fractures. Femur fracture although being relatively a rare complication one of the most common fractures of the lower extremity presenting in newly born babies. In our case, 39-week mature fetus with weight 3,300 g breech presentation delivered by cesarean section presented with subtrochanteric femur fracture left side. A complete healing of the fracture, without any sequelae, was noted when the patient was simply immobilized with hip in flexion, abduction, and external rotation. The possibility of accidental injuries and traumatic complications are significantly reduced in cesarean section, especially in breech delivery when compared with vaginal delivery, but it does not completely eliminate the possible birth injuries and thus fractures of the newborn. So, clinicians must check for fractures even after cesarean section in breech presentation. How to cite this article: Singla S, Sharma R, Sharma R, et al. Subtrochanteric Femur Fracture in Neonates: A Rare Complication after Breech Presentation. J Orth Joint Surg 2020;2(2):79–81.

Vaginal Delivery versus Elective Caesarean Section for Breech Presentation - Experience in Institute of Child and Mother Health (ICMH)

Introduction: Compared with a fetus with cephalic presentation, a breech fetus faces increased risk during labour and delivery of asphyxia from cord compression and of traumatic injury during delivery of the shoulders and head. Caesarean section avoids most of this risk. The purpose of this study was to evaluate the feasibility of vaginal delivery of uncomplicated singleton breech presentation by evaluating early neonatal morbidity and mortality as well as maternal morbidity following vaginal and caesarean delivery for breech presentation.&#x0D; Materials and Methods: This is a cross sectional comparative study.104 women with singleton breech presentation at term in labour were included consequetively in labour ward of Institute of Child and Mother Health (ICMH). Informed consent was taken from them. Neonatal and maternal outcome were recorded and statistical analysis was done using SPSS version 22.&#x0D; Results: APGAR at 5 min and Neonatal Intensive Care Unite (NICU) admission were not affected by mode of delivery. Long term neonatal outcome is similar in either mode of delivery. Maternal morbidity and duration of hospital stay is increased in caesarean births.&#x0D; Conclusion: Neonatal outcome did not depend on mode of delivery though maternal morbidity and cost of care is increased following Caesarean Section. Proper selection of cases and by improving skill &amp; confidence in new generation obstetrician, vaginal delivery of singleton fetuses in breech presentation at term remains a safe option that can be offered to a woman in a tertiary care centre.&#x0D; Medicine Today 2019 Vol.31(1): 23-26

External Cephalic Version: A Dying Art Worth Reviving.

Breech presentation is the most common abnormal presentation occurring in 3-4% of all deliveries. Incidence of caesarean section for breech presentation has increased markedly in the last few decades. Attempting external cephalic version (ECV) reduces the chance of non-cephalic presentation at term, thus reducing the rate of caesarean sections. Prospective study was conducted in secondary healthcare centre, in rural set-up from August 2013 to August 2015. A total of 52 patients were enrolled into the study. ECV was successful in 32 out of 52 patients with overall success of 61.5%. Out of the 32 successful ECVs, 24 patients delivered vaginally (75%) (p value 0.00), 6 patients delivered by caesarean section, and 2 patients were lost to follow-up. Transverse lie had 100% success rate for ECV (p value 0.005). Gravidity, placental position, gestational age and use of tocolytics did not influence the success rate of ECV. Most common problem observed during the procedure was abdominal discomfort. ECV is a safe procedure with high percentage of patients delivering vaginally after successful version. Hence, acquiring skills in ECV should be considered mandatory in the postgraduate training of future obstetricians.

BREECH PRESENTATION AND NEONATAL FRACTURE SHAFT FEMUR – A RARE CASE PRESENTATION

The breech extraction of the fetus through the vagina has a greater risk of hip fracture compared with the extraction by abdominal route. A 2980 g male infant was delivered at 39 weeks by elective cesarean section for breech presentation. The newborn sustained a fracture of the right femur. A simple immobilization of the limb in extension led to a complete healing of the fracture without sequelae. This case highlights that fact that cesarean delivery reduces the risk of causing a traumatic injury of the newborn compared to vaginal delivery; especially, with breech presentation but does not eliminate this possible accidental complication. Key words : Breech presentation, Fracture femur, Neonate

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

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

STUDY OF PERINATAL MORTALITY IN TERM BREECH PRESENTATION WITH INCREASING CAESAREAN SECTION RATE

Breech presentation persists in 3-4% of all term deliveries. There is a threefold increase in perinatal mortality for breech infant delivered vaginally which is related to birth asphyxia and birth trauma. The most frequent cause of death in neonates delivered through breech is intracranial hemorrhage; so many obstetricians recommend caesarean section for breech presentation. It is a retrospective study regarding management of term breech presentation conducted in King George Hospital, Vishakhapatnam from 2012 to 2015 and the results are compared with a similar study conducted in 1981-1984.There is an increase in incidence of caesarean section and decrease in perinatal mortality in our present study when compared to previous study. Increase in caesarean section for breech delivery has decreased the overall incidence of perinatal mortality.

A case report of significant congenital depressed skull fracture after cesarean section delivery

We report a case of depressed skull fracture in an hour old newborn delivered by cesarean section for breech presentation. The depression was surgically corrected as a spontaneous resolution did not occur after some interval. Surgical correction of depressed skull fracture may be indicated depending on the depth of depression and thickness of the bone at involved part of the skull.

Laparoscopic Management of Rudimentary Horn Pregnancy: A Case Report and Review of the Literature

Abstract Background: Rudimentary horn pregnancy is a rare but important cause of gynecologic morbidity and mortality. As the available literature is limited, the optimal surgical approach and techniques have not been defined clearly. Case: This report describes a case of a multiparous woman who presented with painless vaginal spotting. Her history included a previous preterm vaginal birth at 35 weeks' gestation and a subsequent cesarean section for breech presentation. At the current presentation, she was otherwise asymptomatic and had no abnormal examination findings. A transvaginal ultrasound revealed a 3-cm cystic structure in the right adnexa with a thick echogenic wall containing a yolk sac, and a left unicornuate uterus. Diagnostic laparoscopy revealed a unicornuate uterus with a bulging noncommunicating right rudimentary horn measuring 4 cm. Excision of the rudimentary horn and an ipsilateral salpingectomy were performed. Upon excision, it was confirmed that there was no communication between the r...

Vaginal breech births: the debate continues

British Journal of Midwifery • August 2015 • Vol 23, No 8 It is not unusual for me to receive a press release or two a day about a new midwifery study with a headline meant to catch my attention. Most of the time I skim read them for importance and file them away to be read more thoroughly at a later date. However, at the end of last month, my inbox pinged with news of new study published in BJOG about the risks of planned vaginal breech birth compared with planned caesarean section for breech presentation (Berhan and Haileamlak, 2015). The title of the press release—‘Caesarean birth “safest” for breech delivery, but the absolute risks of vaginal delivery remain small’—sparked my attention. At a time when the UK’s caesarean section rate is already too high, at 24.6% (Macfarlane et al, 2015; World Health Organization, 2015), will this study help to contribute to the rising numbers of caesarean sections and undo some of the work done to encourage normal births? The methods of breech birth have been hotly debated for many decades. Hannah et al’s (2000) Term Breech Trial (TBT) transformed breech practice, concluding that a planned caesarean section is better than a planned vaginal birth for a term fetus in the breech presentation: swaying the balance towards an increasingly ‘safer’ practice of caesarean section and away from vaginal breech births. However, the TBT was not what it seemed. Sanders and Steele (2012) discussed the TBT, highlighting the flaws in the design of the study. The authors themselves found that there were no differences in outcomes from mode of birth in their 2-year follow-up (Whyte et al, 2004). Despite this, the recommended method of breech birth remains via caesarean section. On initial reading, Berhan and Haileamlak’s (2015) study agrees with the TBT (Hannah et al, 2000). The results showed that the relative risk of perinatal mortality and morbidity was between two and five times higher in planned vaginal breech birth compared to planned caesarean section birth. However, the absolute risks were very small. It is so important that information on relative vs absolute risk is portrayed accurately to women. Neither vaginal breech birth, nor caesarean breech birth is riskfree. Therefore, a woman must be made fully aware of the risks and benefits of each, in order for her to make a truly informed decision about her care. Vaginal breech birth requires skilled management and continuing to deliver breech babies via caesarean section means that midwives are becoming deskilled in this area. Therefore, understanding these risks and chosing a vaginal breech birth is moot if midwives are not able to offer this service. If the options aren’t available because midwives don’t have the skills, where is the choice and how are we going to achieve the demedicalisation of birth? BJM