Delivery For Breech Presentation Research Articles

Neonatal outcomes of planned vaginal delivery versus planned cesarean section for breech presentation at term: Population-based study on 546,842 breech births across the United States between 2008 and 2017

IntroductionOver the last several decades, cesarean delivery has been recommended as the safest mode of delivery for breech presentations. The purpose of this study was to evaluate the outcomes of planned vaginal births with planned cesarean births in breech presenting fetuses. MethodsThis retrospective population-based cohort study utilized data from the United States’ Period Linked Birth-Infant Death Public Use Files from 2008 to 2017. All term singleton breech deliveries of a live baby without congenital anomalies were identified (n = 546,842) and divided into two cohorts: women who had a planned vaginal birth (n = 116,828), and women who had a planned cesarean section (n = 430,014). Multivariate logistic regression models, adjusted for maternal baseline characteristics, examined the associations between the planned delivery method and neonatal outcomes. ResultsIt was observed that 26.14 % of the planned vaginal birth cohort had a vaginal delivery. In adjusted analyses, undergoing a planned vaginal birth for breech delivery was associated with an increased risk of adverse neonatal outcomes including infant death, OR 1.32, 95 % CI 1.16–1.52, admission to NICU,1.23, 1.19–1.27, ventilation support at 〈 6 h of life, 1.47, 1.42–1.52, ventilation support at 〉 6 h of life, 1.19, 1.08–1.31, and Apgar score of ≤3 at 5 min, 2.27, 2.06–2.50. ConclusionIn women carrying fetuses in breech presentation, having a planned vaginal birth had a low success rate and was associated with increased risk of neonatal morbidity and mortality. Women should be carefully counselled on the risks associated with breech vaginal delivery as well as the low success rate of vaginal delivery.

Confronting the Fear: Our Experience with Breech Vaginal Delivery-A Retrospective Analysis

Introduction: Mode of delivery for term singleton breech presentation has been a raging topic of discussion for decades and continues to be so. The ‘Term Breech Trial’ was a big blow to vaginal breech delivery leading to a torrential increase in the rate of caesarean sections the world over. We intend to compare and evaluate the maternal and perinatal outcomes of vaginal versus caesarean section breech delivery so as to analyse the safety of vaginal delivery for breech presentation. Objectives: Analyse and compare perinatal and maternal outcomes between vaginal versus caesarean deliveries of term or near-term singleton breech presentation. Materials and Methods: Retrospective comparison between 30 vaginal breech deliveries (Group 1) and 252 caesarean deliveries (Group 2) done for singleton breech presentation between 36 weeks to 42 weeks, either in early or advanced labour conducted between January 2015-January 2022 at various Military Hospitals. Statistical Analysis: The association between maternal and perinatal outcomes was estimated using the Chi-square test and Fisher exact test with P < 0.05 considered statistically significant. Results: No maternal complications were noted in Group 1 while in Group 2 surgical site infection and post-partum haemorrhage of varying degree, was noted in 14% cases and 7% cases respectively which was statistically significant. There was no significant difference noted between the groups with regard to neonatal outcomes or NICU admission. Conclusion: Vaginal delivery for termsingleton breech is a reasonable option in well-selected patients at optimally equipped centres, in the hands of an experienced Obstetrician.

Determinants Of The Neonatal Prognosis In Briech Delivery In Primipparous About 627 Cases At The Nabil Choucair Health Center In Dakar, Senegal From 2005 To 2023

OBJECTIVES: The objectives were to describe the frequency and sociodemographic profile of primiparous women with fetuses in breech presentation, and to assess the maternofetal prognosis of breech presentation in primiparous women. MATERIALS AND METHODS: This was a retrospective, descriptive and analytical study carried out at the Nabil Choucair Health Center over a period from January 1, 2005 to December 31, 2023. The study included all primiparous women carrying a singleton pregnancy. whose term was greater than 22 weeks of amenorrhea who came to give birth at the Nabil Choucair health center. Patients whose files were unusable due to a significant number of missing data, as well as terminated pregnancies were excluded. Data entry and analysis were carried out using Excel software. It included two parts: descriptive analysis and analytical analysis. In the descriptive analysis, the quantitative variables were described in number, percentage and average. The analytical study consisted of researching the link between the route of delivery and the parameters which can influence it theoretically and thus as well as the maternofetal prognosis. The Chi2 test was used for comparison of proportion. The difference was statistically significant when the p value was strictly less than 0.05. The Odds surrounded by the 95% confidence interval made it possible to determine the strength of the link. CONCLUSION: Vaginal delivery of breech presentation in primiparous women is still possible in a level II maternity ward with an operating theater. Indications for cesarean section should be reserved for breech presentations in primiparous women associated with other risk factors.

Asuhan Kebidanan Komprehensif Pada Ny. F Umur 26 Tahun G2p0a1 Presentasi Bokong Dengan Persalinan Sectio Caesarea Di Wilayah Kerja Puskesmas Bumiayu Kabupaten Brebes Tahun 2023

Breech presentation is a pregnancy with an elongated position og the baby where the fetal head is in the fundus and the buttocks are the lowest part of the fetus and most fetuses can carry out a spontaneous version of cephalic presentation at term. Pregnancies with breech presentation with a total of 229 people (Indonesia health profile, 2020). Based in the results of pregnancy, childbirth, newborn, postpartum and family planning care, there was only a problem during the first pregnancy visit at 34 weeks of gestation, namely breech presentation. The researcher implemented comprehensive midwifery care using Varney dan SOAP documentation. This research aims to enable pregnant women to know and understand the location, prevention and treatment. This research uses a qualititave descriptive method with a case study approach. Data collection uses interview methods, observation, physical examination, supporting examinations, medical records, KIA books and other literature. Conclusions in the research can be concluded that health research can broaden the knowledge of pregnant women and can also understand the importance of the dangers of breech presentation delivery.

Fetal Outcome in Breech Vaginal Delivery in Multi Gravida Patients

Background: Fetal buttocks or feet positioned at the pelvic inlet are referred to as breech presentation. Both vaginal delivery and Caesarean section are options for them. Everyone agrees that breech deliveries are better handled by caesarian section than by vaginal delivery. Risk factors for breech presentation include uterine abnormalities, prematurity, foetal abnormalities, and repeated pregnancies. This research sought to ascertain the foetal fate in multigravida individuals undergoing breech vaginal birth. Methods: This descriptive case series investigation was carried out at the Khyber Teaching Hospital in Peshawar, in the department of obstetrics and gynaecology. The study was conducted from October 2018 to April 2019, seven (07) months. Patients had thorough clinical examinations and lengthy history interviews. The selected patients were instructed to have normal labour under careful foetal and maternal monitoring supervision. All of the patients that experienced a regular delivery had their specific information entered into the database along with the intrapartum occurrences and immediate foetal outcomes. At five minutes, an apgar score was obtained. Brachial plexus damage, low birth weight, low apgar score, foetal distress, and stillbirth were among the foetal outcomes that were reported. Results: As per fetal outcomes, 35 (16.21%) patients were recorded with low apgar score, 37 (17.05%) patients were registered with low birth weight, 69 (31.79%) patients were recorded with birth asphyxia, 27 (12.44%) patients were recorded with brachial plexus injury, 26 (11.98%) patients were registered with fetal distress and 23 (10.59%) patients were recorded with still birth. Conclusion: This research shown that foetal morbidity comes from vaginal breech deliveries (VBD) of singleton term pregnancies. To prevent these difficulties in our local Khyber Pukhtunkhwa population, we thus highlight the necessity for special safeguards, including close monitoring of labour and enough preparedness for newborn resuscitation. This study may be useful in breech delivery decision-making by helping to personalise each choice by understanding the risks involved. Based on the findings, the technique of delivery in breech presentation should be determined. Keywords: Breech, Vaginal Delivery, Singleton Term Pregnancies, Fetal Morbidity, Multi- Gravida.

Cesarean versus vaginal delivery for breech presentation is an independent risk factor for long-term pediatric respiratory hospitalization of the offspring.

To compare the long-term respiratory morbidity of offspring born by cesarean delivery for breech presentation with that of those delivered vaginally. A population-based cohort analysis including all singleton breech deliveries between the years 1991 and 2014, comparing long-term respiratory morbidity of offspring born in breech presentation, according to mode of delivery. Offspring with congenital malformations, perinatal deaths, and instrumental deliveries were excluded. Respiratory morbidity included hospitalizations (up to age 18 years), as recorded in hospital records. A Kaplan-Meier survival curve compared cumulative respiratory morbidity. A Weibull parametric survival model controlled for confounders and repeat deliveries. A total of 7337 breech deliveries were included; 6376 (86.9%) cesarean deliveries and 961 (13.1%) vaginal breech deliveries. The Kaplan-Meier survival curve demonstrated higher cumulative incidence of respiratory morbidity in the cesarean delivery group compared with vaginal delivery (log rank test P= 0.006). Using a Weibull parametric survival model to control for confounders, cesarean delivery was found to be an independent risk factor for long-term respiratory morbidity of the offspring (adjusted hazard ratio 1.87, 95% confidence interval 1.32-2.65, P< 0.001). Cesarean versus vaginal delivery for breech presentation is an independent risk factor for long-term pediatric respiratory morbidity of the offspring.

Mode of vaginal delivery in breech presentation and perinatal outcome.

To compare a perinatal outcome in breech presentation depending on different modes of vaginal breech delivery (VBD). Over the course of 13 years (2005-2018), perinatal outcome of newborns was compared among 98 singleton pregnancies (64 term pregnancies and 34 preterm pregnancies) completed with VBD divided into six groups depending on the mode of delivery used (Bracht, Müller, Thiessen, classical arm release, Mauriceau-Levret-Veit-Smellie (MLVS), and Vermelin´s spontaneous vaginal delivery). Also, maternal demographic parameters were observed. Of 98 singleton pregnancies, the most frequently used mode was Thiessen (35.71%), followed by MLVS technique (25.51%), Bracht (22.45%), Vermelin (13.27%), classical arm release (2.04%) and Müller (1.02%). Newborns with Apgar score ≤ 7 at 5 min. were transferred to the neonatal intensive care unit (NICU), which included 15.31% of newborns (total 15 newborns: 1 term and 14 preterm newborns). The incidence of episiotomy was 63.27%. Seventy-point five percent of women included in the study were ≤ 35 years of age, and 37.76% were multiparas. Delivery was induced in 7.14% cases. Less- traumatizing actions during VBD have less harmful consequences and better perinatal outcome. Lower Apgar score was noted with the aggressiveness of the mode of VBD.

Pregnancy outcomes in breech presentation at term: a comparison between 2 third level birth center protocols

Medical literature supports planned cesarean delivery for breech presentation at term because of observed reductions in neonatal morbidity and mortality compared with vaginal breech delivery. This study aimed to compare perinatal outcomes of singleton pregnancies with breech presentation at term according to the different delivery protocols of 2 teaching hospitals, where vaginal breech delivery (protocol 1) or cesarean delivery (protocol 2) is routinely offered, respectively. A retrospective matched cohort study was conducted between January 2015 and May 2021. A total of 1079 women were eligible for analysis. After matching for possible confounding factors, the final analysis was performed on 257 patients in each group. The primary outcomes were a composite of adverse obstetrical outcomes and a composite of neonatal adverse outcomes. Overall, 1079 women were eligible for analysis. After matching for possible confounding factors, the final analysis was performed on 257 patients in each group. The composite of adverse obstetrical outcomes was similar in the 2 groups (24.1% vs 24.5%; P=1.000); however, the composite of neonatal adverse outcomes was significantly higher for protocol 1 (17.9% vs 1.2%; P<.001). No neonatal death or birth trauma was reported in either group. The rates of neonatal intensive care unit admission (4.3% vs 0.4%; P=.004), respiratory distress at birth (17.5% vs 1.2%; P<.001), and Apgar scores of <7 after 5 minutes (5.8% vs 0.4%; P<.001) were significantly higher for protocol 1. Short-term, nonsevere adverse neonatal outcomes were significantly increased in the protocol 1 group. These must be balanced against the possible negative effects of cesarean delivery on long-term infant and maternal health.

Impact d’un protocole de service sur la pratique de l’accouchement voie basse des présentations du siège à terme

ObjectivesThe delivery of breech presentations remains controversial. Our study analysed the impact of a service protocol on the proportion of planned vaginal delivery and its success. Immediate neonatal morbidity and factors that may influence the success of vaginal delivery were studied. MethodsRetrospective study, between 2009 and 2020 at the CHRU of Limoges, type 3 maternity hospital, on patients with a breech foetus at term. The proportion of planned vaginal delivery and the rate of effective vaginal delivery were compared before/after 2015. Neonatal morbidity was compared for planned vaginal delivery and planned cesarean delivery groups. ResultsWe included 923 patients. The rate of planned vaginal delivery was significantly higher after 2015 from 5.2% to 19% (P<0.001), with a success rate increasing from 60% to 82.1% (P=0.06). The rate of vaginal breech deliveries significantly increased from 3.8% to 17% (P<0.001). We found significantly more newborns with moderate acidosis when a vaginal delivery was attempted (P<0.001). The success of vaginal delivery was correlated to the Magnin index (P=0.044), to gestational age (P=0.037), and to multiparity (OR 3.78 95% CI [1.42–10.03] P=0.006). ConclusionOur study demonstrates the benefits of setting up a service protocol for the practice of breech vaginal delivery.

Abnormal Lower Extremity Movements in a Term Infant.

Abnormal Lower Extremity Movements in a Term Infant.

Delivery in breech presentation: Perinatal outcome and neurodevelopmental evaluation at 18 months of life

ObjectivesTo compare maternal and perinatal outcomes, including neurodevelopmental results at 18 months of life, between term breech and cephalic deliveries. Study designIn this longitudinal retrospective study of mothers seen at the Maternity and Paediatric University Hospital of the Canary Islands delivery unit from November 1, 2011, to October 31, 2012, we compared maternal and perinatal outcomes associated with breech or cephalic presentation of the foetus. A second analysis was performed to compare breech births, differentiating between whether a vaginal delivery attempt was made or if caesarean section (C-section) without labour had been directly scheduled. The psychomotor development of children 18 months after birth was assessed using the Haizea-Llevant scale. ResultsA total of 130 breech deliveries were matched with 130 cephalic deliveries. No perinatal mortality occurred in either group. The C-section percentage was greater in the breech presentation group compared with the cephalic delivery group (72.3 % vs. 14.6 %; p < 0.001). Children in the breech presentation had a threefold increased risk for Apgar scores <7 at 1 min (OR 3.2; 95 % CI: 1.2–8.4; p = 0.016) compared with cephalic presentation. These differences disappeared 5 min after birth. No differences were observed in moderate to severe neonatal morbidity between the breech and cephalic presentation groups. There were no differences between groups in neurodevelopmental outcomes.Of 130 pregnancies with breech presentation, 79 (60.8 %) made a vaginal delivery attempt, and 51 (39.2 %) were planned C-sections. Women who attempted vaginal breech delivery were younger and had a history of previous pregnancy. Apgar scores <7 at 1 min were more frequent in the vaginal delivery attempt group (27.9 % vs. 5.9 %; p = 0.002). A high percentage of type III resuscitation (36.5 % vs. 14.3 %; p = 0.007) and Neonatology admission (22.8 % vs. 5.9 %; p = 0.013) was observed in the vaginal delivery attempt group. Except for Apgar scores <7 at 1 min, none of these associations was significant after adjusting for nulliparity and maternal age. The mode of delivery was not associated with moderate to severe perinatal outcomes. ConclusionThe implementation of a specific protocol for selecting pregnant women with breech presentation as candidates for vaginal delivery achieved perinatal outcomes similar to births in cephalic presentation.

Breech Presentation and Maternal and Perinatal Outcome in a Tertiary Care Teaching Hospital of Central Nepal

Introduction: Breech is the commonest malpresentation. The objective of this study is to find out the prevalence of breech presentation at term. It also aims to present the mode of delivery conducted and to highlight the maternal and fetal complications associated with it. Methods: This was a descriptive cross-sectional study conducted in Department of Obstetrics and Gynaecology department of College of Medical Sciences done over a period of 2 years. All term pregnant women (≥ 37 weeks) aged 16 years and above, admitted to the maternity and labor ward with the diagnosis of singleton breech presentation during the study period were included in the study. Results: The incidence of breech presentation at term was 5.03%. Out of these, only 7 (18.92%) patients underwent breech vaginal delivery. Mean maternal age was 28.07 (± 11.56) years and majority were primigravidae. The mean birth weight of newborn was 2.8±0.5 kg. Conclusions: Breech presentation can result in both maternal and fetal complications. Skills related to conducting delivery in breech presentation must be learned by all those who manage pregnant women.&#x0D;

Decline of Obstetrical Medical Technique and Its Social Acceptance : Is the Loss of Vaginal Delivery for Breech Presentation resulted from Oppression for the Pregnant Women

Decline of Obstetrical Medical Technique and Its Social Acceptance : Is the Loss of Vaginal Delivery for Breech Presentation resulted from Oppression for the Pregnant Women

1118: Cesarean delivery for breech presentation as a risk-factor for long-term gastrointestinal morbidity of the offspring

1118: Cesarean delivery for breech presentation as a risk-factor for long-term gastrointestinal morbidity of the offspring

Breech presentation delivery care: A review of childbirth semiology, mechanism and care

To review the concepts underlying breech presentation delivery as well as the semiology and the obstetric maneuvers contributing to a successful perinatal maternal outcome. Based on a hypothetical scenario to set the stage for a practical approach to the topic, an explanatory paper built on a narrative review is created in order to examine the principles related to diagnosis, mechanism of delivery and maternal care, emphasizing maneuvers to ease fetal extraction. Breech presentation delivery must be managed through the vaginal canal when already in the expulsion phase with fetal engagement. For diagnosis and care, it is essential to know the unique semiology and physiology of this condition as well as the obstetric maneuvers to facilitate an uncomplicated delivery. The mechanism of childbirth in breech presentation is complex and requires knowledge of its physiology and multiple obstetric maneuvers on the part of the obstetrician as well as the general practitioner, in order to ensure adequate care when there is no other option.

Is induction of labor a reasonable option for breech presentation?

Whereas spontaneous onset of labor and vaginal delivery for breech presentation is considered to be a safe and effective option in selected cases, the safety of induction of labor is not established yet. The objectives of this study were to describe the outcomes of pregnancy in women induced with a fetus in breech presentation and compare the outcomes with those undergoing planned cesarean delivery. We performed a secondary analysis of the observational prospective multicenter PREMODA study, including all singleton breech deliveries after 37weeks in 174 centers in France and Belgium. We excluded women with spontaneous onset of labor, scarred uterus or intrauterine fetal death. Our study population consisted of women with either induction of labor or 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. Our study population consisted of 4138 women, 218 with induction of labor and 3920 with planned cesarean. Two-thirds (67.4%) of the women in the induction of labor group delivered vaginally. There was no significant difference between the groups for the primary outcome (48 [1.2%] in the planned cesarean group vs 3 [1.4%] in the induction of labor group, P=0.75). Moreover, none of the criteria of the composite primary outcome was significantly more frequent in the induction of labor group. Induction of labor for breech presentation does not seem to increase neonatal mortality or severe neonatal morbidity compared with planned cesarean delivery.

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

Trends in mode of delivery for breech presentation in Japan: ‘Transverse figure 8 breech delivery’

Trends in mode of delivery for breech presentation in Japan: ‘Transverse figure 8 breech delivery’

Changing Trends in the Delivery of Breech Presentation throughout the Last Four Decades

Changing Trends in the Delivery of Breech Presentation throughout the Last Four Decades

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.