Incidence Of Breech Presentation Research Articles

The impact of a routine late third trimester growth scan on the incidence, diagnosis, and management of breech presentation in Oxfordshire, UK: A cohort study.

Breech presentation at term contributes significantly to cesarean section (CS) rates worldwide. External cephalic version (ECV) is a safe procedure that reduces term breech presentation and associated CS. A principal barrier to ECV is failure to diagnose breech presentation. Failure to diagnose breech presentation also leads to emergency CS or unplanned vaginal breech birth. Recent evidence suggests that undiagnosed breech might be eliminated using a third trimester scan. Our aim was to evaluate the impact of introducing a routine 36-week scan on the incidence of breech presentation and of undiagnosed breech presentation. We carried out a population-based cohort study of pregnant women in a single unit covering Oxfordshire, United Kingdom. All women delivering between 37+0 and 42+6 weeks gestational age, with a singleton, nonanomalous fetus over a 4-year period (01 October 2014 to 30 September 2018) were included. The mean maternal age was 31 years, mean BMI 26, 44% were nulliparous, and 21% were of non-white ethnicity. Comparisons between the 2 years before and after introduction of routine 36-week scan were made for 2 primary outcomes of (1) the incidence of breech presentation and (2) undiagnosed breech presentation. Secondary outcomes related to ECV, mode of birth, and perinatal outcomes. Relative risks (RRs) with 95% confidence intervals (CIs) are reported. A total of 27,825 pregnancies were analysed (14,444 before and 13,381 after). A scan after 35+0 weeks was performed in 5,578 (38.6%) before, and 13,251 (99.0%) after (p < 0.001). The incidence of breech presentation at birth did not change significantly (2.6% and 2.7%) (RR 1.02; 95% CI 0.89, 1.18; p = 0.76). The rate of undiagnosed breech before labour reduced, from 22.3% to 4.7% (RR 0.21; 95% CI 0.12, 0.36; p < 0.001). Vaginal breech birth rates fell from 10.3% to 5.3% (RR 0.51; 95% CI 0.30, 0.87; p = 0.01); nonsignificant increases in elective CS rates and decreases in emergency CS rates for breech babies were seen. Neonatal outcomes were not significantly altered. Study limitations include insufficient numbers to detect serious adverse outcomes, that we cannot exclude secular changes over time which may have influenced our results, and that these findings are most applicable where a comprehensive ECV service exists. In this study, a universal 36-week scan policy was associated with a reduction in the incidence but not elimination of undiagnosed term breech presentation. There was no reduction in the incidence of breech presentation at birth, despite a comprehensive ECV service.

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;

Impact of implementation of a breech clinic in a tertiary hospital

BackgroundThe incidence of breech presentation in single pregnancies at term is between three to 5 %. In order to support eligible women in their choice of mode of delivery, a dedicated breech clinic with a care pathway was developed in December 2015 in a tertiary referral centre in Brussels.The primary objective of this study was to evaluate the vaginal birth rate before and after the introduction of a dedicated breech clinic. The secondary objective was to compare the early neonatal outcomes before and after the breech clinic was introduced.MethodsThis was a single centre retrospective and prospective study. The inclusion criteria were term (from 37 weeks), singleton fetus and breech presentation at delivery. The exclusion criteria were suspected intrauterine growth restriction, severe fetal malformations and intrauterine fetal demise. We used a composite outcome as an indicator of neonatal morbidity and mortality.ResultsAfter the introduction of the breech clinic, we observed a significant increase in planned vaginal delivery from 7.4% (12/162) to 53.0% (61/115) (OR: 13.5; 95% CI: 6.7–27.0). The effective vaginal breech delivery rate (planned and unexpected) significantly increased from 4.3% (7/162) pre-implementation of breech clinic to 43.5% (50/115) post-implementation (OR: 17.0; 95% CI: 7.3–39.6). Neonatal outcomes were not statistically different between the before and after periods.ConclusionThe introduction of a dedicated breech clinic has led to an increase in vaginal deliveries for breech babies without adversely affecting neonatal outcomes.

A comparison of risk factors for breech presentation in preterm and term labor: a nationwide, population-based case\u2013control study

PurposeTo determine if the common risks for breech presentation at term labor are also eligible in preterm labor.MethodsA Finnish cross-sectional study included 737,788 singleton births (24–42 gestational weeks) during 2004–2014. A multivariable logistic regression analysis was used to calculate the risks of breech presentation.ResultsThe incidence of breech presentation at delivery decreased from 23.5% in pregnancy weeks 24–27 to 2.5% in term pregnancies. In gestational weeks 24–27, preterm premature rupture of membranes was associated with breech presentation. In 28–31 gestational weeks, breech presentation was associated with maternal pre-eclampsia/hypertension, preterm premature rupture of membranes, and fetal birth weight below the tenth percentile. In gestational weeks 32–36, the risks were advanced maternal age, nulliparity, previous cesarean section, preterm premature rupture of membranes, oligohydramnios, birth weight below the tenth percentile, female sex, and congenital anomaly. In term pregnancies, breech presentation was associated with advanced maternal age, nulliparity, maternal hypothyroidism, pre-gestational diabetes, placenta praevia, premature rupture of membranes, oligohydramnios, congenital anomaly, female sex, and birth weight below the tenth percentile.ConclusionBreech presentation in preterm labor is associated with obstetric risk factors compared to cephalic presentation. These risks decrease linearly with the gestational age. In moderate to late preterm delivery, breech presentation is a high-risk state and some obstetric risk factors are yet visible in early preterm delivery. Breech presentation in extremely preterm deliveries has, with the exception of preterm premature rupture of membranes, similar clinical risk profiles as in cephalic presentation.

A study of labour outcome in breech delivery

Aim: Breech is the most common form of malpresentation. It is defined as when foetus occupies a longitudinal lie with the pelvic extremity at the pelvic brim and head at the fundus of the uterus. The present study was conducted on 100 cases of breech presentation to find out the labour outcome in breech deliveries and various factors affecting it. Materials and Methods: The present study was conducted in the Department of Obstetrics and Gynaecology, Umaid Hospital, attached to Dr. S.N. Medical College, Jodhpur. A total of 100 cases of breech presentation including single as well as plural pregnancies in which one or more foetuses were presenting as breech were taken. Both booked and unbooked cases in primigravidae and multigravidae were studied. The cases were selected at random among those who got admitted in labour room. Results: In the present series, incidence of breech deliveries came to be 4.1094%. Incidence of breech presentation was maximum (45%) in the age group of 21–25 years. In this study, out of 100 cases, 62 were multigravidae and 38 were primigravidae, and 43 cases (43%) were associated with factors which endanger of life of the foetus, among which twin pregnancy and pre-eclamptic toxaemia were the most commonly associated factors. In the present series, among 100 cases studied, 14 were breech babies and congenital malformation, of which hydrocephalus was the most common malformation found. Conclusion: The study concludes that prematurity is associated with high incidence of breech presentation. The most common variety of breech presentation is flexed breech, which is found more in multigravidae. Caesarean section is the mode of delivery of choice as it carries minimal foetal loss. Extended variety of breech is safest for the baby and carries minimal foetal loss.

Breech Presentation: Vaginal Delivery or Caesarean Section?

The incidence of breech presentation is approximately 3,97%. Breech presentation is considered as being “borderline eutocic” and it requires carefully monitoring both the foetus and the mother. The aim of the current paper is to evaluate the preffered method of delivery in case of breech presentation. The paper presents a retrospective study performed in the Obstetrics and Gynaecology Departments of the County Emergency Clinical Hospital “Sf. Apostol Andrei” in Constanta, during a period of 5 years (2010-2014). The methods of birth were analyzed for a lot of 1104 patients with breech presentation with ages ranging between 16 and 44 years old. The total number of patients who gave birth through vaginal delivery was of 139 patients, amounting to 12.59% of the total population sample. The number of patients that gave birth through C-section was 965, which amounts to 87.4% of the total population sample. Birth through C-section is preferred by both obstetricians and patients alike, due to the fact that vaginal delivery is associated with a higher foetal risk in breech presentation.

Breech Presentation: Vaginal Delivery or Caesarean Section?

The incidence of breech presentation is approximately 3,97%. Breech presentation is considered as being “borderline eutocic” and it requires carefully monitoring both the foetus and the mother. The aim of the current paper is to evaluate the preffered method of delivery in case of breech presentation. The paper presents a retrospective study performed in the Obstetrics and Gynaecology Departments of the County Emergency Clinical Hospital “Sf. Apostol Andrei” in Constanta, during a period of 5 years (2010-2014). The methods of birth were analyzed for a lot of 1104 patients with breech presentation with ages ranging between 16 and 44 years old. The total number of patients who gave birth through vaginal delivery was of 139 patients, amounting to 12.59% of the total population sample. The number of patients that gave birth through C-section was 965, which amounts to 87.4% of the total population sample. Birth through C-section is preferred by both obstetricians and patients alike, due to the fact that vaginal delivery is associated with a higher foetal risk in breech presentation.

Outcome of external cephalic version in breech presentation

Breech presentation is the most common abnormal foetal presentation with an incidence of 3–4% at term. It is associated with increased perinatal mortality and morbidity irrespective of the route of delivery. There is higher incidence of premature rupture of membranes, premature labour, prolapsed cord, traumatic deliveries, perinatal mortality and morbidity including various birth injuries, which makes breech an unfavourable presentation. Not only is the foetal asphyxia more commonly seen in breech, the incidence of traumatic morbidity like intracranial haemorrhage, visceral injuries, fractures, dislocations, and peripheral nerve injuries are encountered more frequently.1 With the passage of time, the art of assisted breech delivery has suffered significant setback. Most of the cases of unfavourable presentation like breech are subjected to caesarean section in the current obstetric practice. The elective caesarean section does not guarantee the improved outcome of the baby and may also increase the risk for the mother, compared to vaginal delivery.2 This situation is further compounded by current small family norms and fear of litigation. In view of this, converting an unfavourable presentation like breech into cephalic presentation by carrying out an external cephalic version (ECV) is a viable option. With ECV the expected 3–4% incidence of breech presentation at delivery may be reduced to 1%. Besides, ECV may also protect against premature labour, its complications, and permit a higher percentage of term deliveries as 20–30% of obstetric patients with breech presentation deliver prematurely.3 External cephalic version is also a potentially hazardous procedure. There is increased risk of ante partum haemorrhage, foeto-maternal haemorrhage, and foetal distress, rupture of membranes, placental abruption, and cord complications. External cephalic version is a strong stimulant of foeto-placental unit as evident by increased middle cerebral arterial blood flow and increased cell free foetal deoxyribonucleic acid in maternal circulation. In the hands of an experienced surgeon and with aid of tocolytics, ultrasonography, and cardiotocography the overall success rate of the procedure is 77% with very small risk of complications.4 Moreover, low cost, ease of procedure, and patient preparation are the added advantages. The delay to attempt ECV at or after 37 weeks of gestation has obvious advantages like management of complications by emergency caesarean section, giving time for spontaneous version to take place with the requirement of fewer procedures.5,6 Thus, there are some uncertainties related to the role and outcome of ECV in breech presentation. The present study aims to determine the outcome of ECV in breech presentation.

Does the Advice to Assume the Knee-Chest Position at the 36th to 37th Weeks of Gestation Reduce the Incidence of Breech Presentation at Delivery?

Breech presentation remains a hazard for the mother and her fetus. To reduce its incidence at delivery, postural techniques have been used, among which the knee- chest position. The objective of this study was to assess the effectiveness of this position on cephalic version of breech presentation. It was a prospective randomized study in a group of 102 women with viable fetuses in breech presentation at 36 to 37 weeks of gestation. The 49 women of the intervention group assumed the knee-chest position for 15 minutes three times a day for one week. The control group had 53 cases. The study and control groups were reviewed after a week to assess the fetal presentation. The version rate was 61% and 20% in intervention and in control groups, respectively (P value = .03). This position should be advised to women with fetus in breech between 36 and 37 weeks of gestation.

Comparison of Eastern and Western Paradigms for Risk Factors for Breech Presentation

Breech presentation occurs in 2–4% of all pregnancies and is associated with increased neonate morbidity and mortality. While the incidence of breech presentation appears to be similar cross-culturally, the West and East have strikingly different explanatory models for its occurrence. The West posits that breech presentation is due to a mechanical problem related to the mother or the infant. The East posits that breech presentation is due to impaired psycho-social-cultural relationships. In this presentation the published evidence for each paradigm is reviewed and original data from The Breech Baby Study are presented followed by evidence for clinical intervention.

Epidemiology of risk factors associated with the management of breech presentation.

Summary A six year review of the 3 major hospitals is carried out to identify the risk factors associated with management of breech presentation. There were 1200 singleton breech presentations at delivery irrespective of gestation out of 63,611 total deliveries. The incidence of breech presentation was therefore 1 in 53 or 1.9 per cent. The crude perinatal mortality was 246 per 1000. And this represented 11.3% of the institutional perinatal mortality. The risk factors identified included the institution during delivery, the attendant and mode of delivery and the fetal weight. The best perinatal outcome was in those delivered by Caesarean section. We have advocated more liberal use of Caesarean section.

Does a Probability of Breech Presentation of More Than 50% Exist Among Diseases and Medical Conditions?

The aim was to study the effect of twin gestations in a uterus with 2 bodies on the probability of breech presentation at delivery. The hypothesis was that the probability of breech presentation was not higher than 50%. A review was undertaken of MEDLINE (1966-2004) and of the article reference list for statistical analysis of presentation at delivery among twins in a normal uterus, singleton gestations in a uterus with 2 bodies, and case studies of twins in a uterus with 2 bodies. There are 10 studies of twin gestations in a normal uterus (Twin A 3036 cases, breech presentation 22.36%; Twin B 2758 cases, breech presentation 36.87%), 2 studies of singleton gestations in a uterus with 2 bodies (297 cases, breech presentation 42.09%), and 57 case report studies of twin gestations in a uterus with 2 bodies (Twin A 56 cases, breech presentation 14.29%; Twin B 54 cases, breech presentation 18.52%). The odds ratio and chi-square test for differences in probabilities show a significantly lower incidence of breech presentation for twins in a uterus with 2 bodies compared with twins in a normal uterus (Twin A, odds ratio = 0.58; chi(2) = 2.08, p > .05, Twin B, odds ratio = 0.39, chi(2) = 7.67, p < .05), and singleton gestations in a uterus with 2 bodies (Twin A, odds ratio = 0.23, chi(2) = 15.51, p < .05; Twin B, odds ratio = 0.31, chi(2) = 10.72, p < .05). Twin gestations in a uterus with 2 bodies decrease the probability of breech presentation.

Tocolysis for Repeat External Cephalic Version in Breech Presentation at Term: A Randomized, Double-Blind, Placebo-Controlled Trial

External cephalic version (ECV) lowers the incidence of breech presentation at term and limits the need for cesarean section in noncephalic births. Although tocolytic agents may improve success rates, they are time-consuming, may cause side effects, and have not been documented to lower rates of section delivery. The investigators attempted to determine whether tocolysis is helpful when ECV is tried again after an initial failed attempt. Using a randomized, double-blind, placebo-controlled design, 124 women with breech presentation at term were enrolled in the study. All of them had undergone attempted ECV without tocolysis but had failed to respond. None of them had an abnormal cardiotocograph after the attempt and none had heart disease, diabetes, or hypertension. Participants were randomly assigned to receive either tocolysis with ritodrine or placebo during a repeat attempt at ECV. Ritodrine at a concentration of 3 mg/mL was administered by syringe pump, starting at 1 mL/hour and increasing up to a maximum of 5 mL/hour. The mother's pulse was kept below 120 beats/min. A decrease in the need for elective cesarean section for breech presentation was the major reason for a decrease in operative deliveries. The frequency of cephalic presentation at delivery was significantly increased after tocolysis (relative risk [RR], 3.21; 95% confidence interval [CI], 1.23-8.39). The incidence of cesarean section declined (RR, 0.33; 95% CI, 0.14-0.80). For multiparous women, the RR for cephalic presentation at delivery was 9.38 (95% CI, 1.64-53.62). No significant effect of tocolysis was evident in nulliparous women. There were no changes in maternal or neonatal morbidity. Although pain scores did not differ between the active treatment and placebo groups, only one woman remained totally free of pain and approximately three fourths of women experienced discomfort. A second attempt at ECV for breech presentation will be substantially more effective if tocolysis is used, and fewer cesarean sections will be necessary. Using tocolysis only after a first attempt at ECV has failed, rather than in all nulliparous women, may well produce higher overall success rates with fewer side effects.

Breech birth at term: vaginal delivery or elective cesarean section? A systematic review of the literature by a Norwegian review team

Breech birth at term: vaginal delivery or elective cesarean section? A systematic review of the literature by a Norwegian review team

A prospective audit of external cephalic version at term: are ultrasound parameters predictive of outcome?

This prospective study was designed to audit our provision of external cephalic version (ECV) but also to assess the relative importance of various ultrasound markers as indicators of a successful outcome. Data were collected between November 1998 and November 1999. There were 102 breech presentations at term and 47 women had an external cephalic version. We had an overall success rate of 55% with no adverse outcomes. Parity, a non-extended breech presentation and posterior placenta were all independently associated with a higher success rate. As only 49% of women with an uncomplicated breech presentation at term agreed to have an ECV the audit has prompted us to assess how we might improve the uptake of our service. Given that fetal position and placental site seem to influence outcome, we would suggest that a basic ultrasound scan should form part of the procedure. The audit has confirmed the value of ECV in reducing the incidence of breech presentation at term. With the increasing caesarean section rate for this obstetric problem it is important that all units in the United Kingdom are able to provide this service.

The implementation of external cephalic version at term for singleton breech presentation--how can we further increase its impact?

The overall incidence of breech presentation at delivery remained at 2 to 3% in a unit where external cephalic version (ECV) was the preferred treatment option for term singleton breech presentation. The objective of this study was to investigate which factors accounted for this high residual incidence, so that the impact of ECV could be further increased. All breech deliveries and ECVs over a 1-year period in a teaching hospital are reviewed. The incidence of term singleton breech delivery was 1.96% among 7,702 total deliveries. There were 115 patients counselled for ECV, of which 15.7% declined the offer and 4.1% went into labour before their scheduled ECV. Among the 93 ECVs performed, 74 were successful and 56 delivered vaginally in cephalic presentation. ECV was not performed in 131 cases. The major reasons were patients' refusal (13.7%), breech first diagnosed in labour or after rupture of membranes (44.3%), oligohydramnios or growth retardation (9.9%) and previous Caesarean section (8.4%). Only 5 patients were not counselled for ECV in the absence of contraindications. The practice of ECV reduced the overall Caesarean section rate by 0.65%, or 4.3% of the total number of Caesarean sections. In conclusion, ECV at term definitely reduces the Caesarean section rate. However, it is unlikely that the overall Caesarean section rate could be reduced by more than 1% even with 100% uptake of ECV unless the use of ECV is to be extended to those with prior Caesarean section, ruptured membranes, oligohydramnios, growth retardation or those who are in labour.

The course and outcome of pregnancy in women with epilepsy—a 6-year prospective study

SummaryNinety-five pregnancies among 88 epileptic women were studied prospectively between 1982 and 1988. There were six miscarriages, three preterm pregnancies and 86 term pregnancies, resulting in 92 babies. There were no stillbirths, one neonatal death and one maternal death. The incidence of breech presentation and mode of delivery amongst epileptic mothers did not differ from that amongst control mothers delivering in the same unit. Birth weight and head circumference of the babies born to epileptic mothers did not differ from those of babies born to control mothers. There was also no difference in head circumference between babies born to epileptic mothers on different anticonvulsant regimens. There were eight minor and one major congenital malformations amongst the 92 babies. The incidence of talipes was 43·5 per 1000 live births, which is significantly greater than the 2·54 per 1000 incidence in the Plymouth Health Authority population. Poor control of epilepsy was not associated with malformation...

ANESTHETIC CONSIDERATIONS IN PREMATURE BIRTH

Premature birth still accounts for about 75% of perinatal mortality. Although great strides have been made in the care of premature babies over the past two decades, markedly decreasing mortality, the prevention of premature birth has not been greatly improved. Although tocolysis, particularly with the beta-2 agonists and magnesium sulfate, may delay birth and allow fetal maturation, it poses several risks which, if not recognized, can cause serious morbidity and even mortality. The use of these drugs and other less widely used tocolytics has important implications for the anesthesiologist. The premature infant itself is subjected to such risks as RDS, IVH, NEC, asphyxia, hypothermia, increased incidence of breech presentation, metabolic disturbances, and predisposition for trauma. To ensure safe delivery, premature babies should be delivered in a tertiary care center equipped and ready to attend to their needs. Major conduction block, particularly continuous lumbar epidural analgesia, is an ideal form of analgesia for the delivery of most premature neonates. Properly administered, it maintains maternal physiology, is not associated with drug depression in the newborn, enables a controlled, atraumatic vaginal delivery, and has little interaction with tocolytics (and indeed may protect against some of their side effects). It is ideal for a trial of labor and, if initiated early, allows for an emergency cesarean section. Continuous lumbar epidural block and subarachnoid block are both superb for elective or urgent cesarean section. However, when their use is contraindicated, inhalation analgesia for vaginal delivery or general anesthesia for cesarean section can be safely administered from the standpoint of both mother and child. Expertly administered anesthesia is not a luxury but is indeed indispensable for successful premature delivery.

The grand multipara—still an obstetric problem

SummaryIn an analysis of a series of 12 636 consecutive deliveries at the Riyadh Armed Forces Hospital, 1103 (8.7 per cent) were undergoing their eighth or subsequent pregnancy. The maternal and perinatal mortality rates rose with increasing parity. There was an increase in the incidence of breech presentation, cord prolapse, the need for obstetric intervention by caesarean section, multiple pregnancy and post-partum haemorrhage in the grand multiparous patients. Haernorrhage during pregnancy related to premature separation of the placenta and bleeding of undetermined origin were most common in grand multiparous patients. The forceps and ventouse delivery rate was higher in primiparous women and least frequent in the grand multiparae. There was one maternal death but no cases of ruptured uterus. Grand multiparity is still an obstetric problem.

Breech presentation associated with anticonvulsant drugs

SummaryIn a 2-year prospective study of anticonvulsant therapy in pregnancy, 5 term breech presentations (12 per cent) were discovered in 42 patients who took anticonvulsant drugs throughout pregnancy to term. This incidence of breech presentation was statistically greater (P<0-025) than in a control hospital population (4 per cent). There was a strong correlation between maternal and cord serum drug concentrations at delivery (r = 0-95) indicating the degree of fetal exposure to the drug. No other predisposing factors were discovered and it was concluded that there is an association between anticonvulsant drug use in pregnancy and breech presentation.