Section For Breech Presentation Research Articles

Indications for caesarean section in breech presentation

Objective: The study was conducted because of the still considerable controversies about the variation in obstetric management in breech presentation, in combination with the still increasing caesarean section rate for this type of presentation, as well as doubt concerning the assumed improvement in neonatal and maternal morbidity and mortality obtained by increasing section rate in breeches. Study design: Two hundred and sixty eight consecutive breech presentations in two university hospitals were studied longitudinally and prospectively. In principle, vaginal delivery was attempted in all cases, under expert supervision and electronic monitoring, except in the presence of clear-cut contraindications. X-ray pelvimetry was not used. Results: The incidence of caesarean section was 34%. The trial of vaginal delivery succeeded in 64% of the nulliparas and in 60% of the non-frank breeches, without statistically significant differences in outcome measures compared with the multiparous women and the frank group, respectively. Hyperextension of the foetal head rarely occurred. Conclusion: Several classic obstetric factors have a lower discriminating value for the route of delivery than is currently assumed. Progress of labour was an important factor in determining the route of delivery.

Effect of mode of delivery on perinatal results in singleton breech presentation weighing 1500 g

Summary The object of this retrospective study was to evaluate the mode of delivery and perinatal outcome of singleton fetuses with breech presentation weighing 1500 g. Consecutive cases of all singleton pregnancies at the Princess Badeea Teaching Hospital in North Jordan in the years 1994 and 1995 were compared for crude and corrected perinatal mortality and effect of mode of delivery by weight after correction for non-preventable causes. There were no differences in the 1 and 5 minutes Apgar scores and corrected perinatal mortality between those delivered vaginally and abdominally. It is concluded that poor perinatal outcome are primarily related to factors other than breech presentation. The mode of delivery for infants weighing 1500 g does not influence neonatal outcome and therefore caesarean section for breech presentation in this group is not justified.

National audit on the practice and training in breech deliveries in the United Kingdom

Objective: To assess training in breech delivery in the United Kingdom at the level of registrar. Method: Three hundred and nineteen registrars in obstetrics and gynecology in the United Kingdom replied to a postal questionnaire. Results: The various indications of cesarean section in breech presentation answered by respondents were: pre-term labor, pelvimetric measurement of inlet/outlet less than 11.5 cm, primigravida, no spontaneous labor, estimated fetal weight less than 2.5 kg or more than 3.5 kg, non-progression of labor in active phase, non-delivery after one hour of active pushing in second stage. A total of 190 respondents (60%) felt that they had been given sufficient training in vaginal breech delivery but only 125 respondents (39%) had the training in the United Kingdom. Conclusion: There is a high rate of cesarean section in breech presentation due to inadequate training of junior staff in vaginal breech delivery.

Cesarean Section

OBJECTIVE: To examine the effect of recommendations to reduce the cesarean section rate issued by the National Consensus Conference on Aspects of Cesarean Birth in 1986 on obstetric practices and to identify current patient factors that predict cesarean section. DESIGN: Descriptive retrospective cross-sectional study. SETTING: A tertiary care perinatal referral centre and a general teaching hospital with a level 2 nursery in Hamilton, Ont. PATIENTS: All patients who gave birth at the two hospitals in 1982 (4121 women) and 1990 (4431). MAIN OUTCOME MEASURES: Cesarean section rates and indications and predictors of cesarean section. RESULTS: Although a trial of vaginal delivery after cesarean section was offered 93% more often in 1990 than in 1982 (p = 0.0002), the rate of vaginal delivery increased only 2.6%, for a reduction of 8.7% in the total cesarean section rate and of 15% in the repeat cesarean section rate. The incidence rate and treatment of dystocia did not change. The rate of cesarean section for breech presentation remained unchanged, and fetal distress was rarely confirmed with pH measurement in scalp blood before cesarean section. The most important predictors of cesarean section in 1990 were previous cesarean section and labour induction. For the nulliparous women and the multiparous women with no previous cesarean section labour induction was the most important predictor. CONCLUSIONS: The rate at which patients with previous cesarean section are offered a trial of vaginal delivery has increased significantly since 1982; however, the total and repeat cesarean section rates have not decreased proportionally. Induction of labour is currently the most important correctable predictor of cesarean section. The active management of dystocia, efforts to increase the rate of vaginal breech delivery and appropriate methods to diagnose fetal distress need to be improved; such improvements should reduce the cesarean section rate further.

Indications for caesarean section: experience in a district general hospital.

Out of 661 deliveries in a district general hospital in 3 Months, 100 (15·1 per cent) were by caesarean section. Of these, 35 sections were performed for delay in the first stage, 16 for breech presentation, 9 for fetal distress and 12 were repeat operations. The study suggests that fewer inductions in the presence of an unfavourable cervix and fewer sections for breech presentation might reduce the caesarean section rate.