Singleton Breech Research Articles

Corrigendum to "Prevalence and Perinatal Outcomes of Singleton Term Breech Delivery in Wolisso Hospital, Oromia Region, Southern Ethiopia: A Cross-Sectional Study".

[This corrects the article DOI: 10.1155/2017/9413717.].

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.

What is the safest mode of birth for extremely preterm breech singleton infants who are actively resuscitated? A systematic review and meta-analyses.

The safest delivery mode of extremely preterm breech singletons is unknown. To determine safest delivery mode of actively resuscitated extremely preterm breech singletons. We searched Cochrane CENTRAL, MEDLINE, EMBASE, CINAHL and ClinicalTrials.gov from January 1994 to May 2017. We included studies comparing outcomes by delivery mode in actively resuscitated breech infants between 23+0 and 27+6 weeks. We synthesised data using random effects, generated odds ratios, 95% confidence intervals and number-needed-to-treat (NNT). Our primary outcomes were death (neonatal, before discharge, or by 6 months) and severe intraventricular haemorrhage (grades III/IV), stratified by gestational age (23+0 -24+6 , 25+0 -26+6 , 27+0 -27+6 weeks). We included 15 studies with 12 335 infants. We found that caesarean section was associated with a 41% decrease in odds of death between 23+0 and 27+6 weeks [odds ratio (OR) 0.59, 95% CI 0.36-0.95, NNT 8], with the greatest decrease at 23+0 -24+6 weeks (OR 0.58, 95% CI 0.44-0.75, NNT 7). The OR at 25+0 -26+6 and 27+0 -27+6 weeks were 0.72 (95% CI 0.34-1.52) and 2.04 (95% CI 0.20-20.62), respectively. We found that caesarean section was associated with 49% decrease in odds of severe intraventricular haemorrhage between 23+0 and 27+6 weeks (OR 0.51, 95% CI 0.29-0.91, NNT 12), whereas the OR at 25+0 -26+6 and 27+0 -27+6 was 0.29 (95% CI 0.07-1.12) and 0.91 (95% CI 0.27-3.05), respectively. Caesarean section was associated with reductions in the odds of death by 41% and of severe intraventricular haemorrhage by 49% in actively resuscitated breech singletons < 28 weeks of gestation. The data are mostly observational, which may be inherently biased, and scarce on other morbidities, necessitating thorough discussion between parents and clinicians. Caesarean section associated with lower odds of death and severe intraventricular haemorrhage in actively resuscitated breech singletons <28 weeks.

Uptake of external cephalic version for term breech presentation: an Australian population study, 2002\u20132012

BackgroundThe safety, efficacy, and cost-effectiveness of external cephalic version (ECV) for term breech presentation has been demonstrated. Clinical guidelines recommend ECV for all eligible women, but the uptake of this procedure in the Australian healthcare setting is unknown. This study aimed to describe ECV uptake in New South Wales, the most populous state of Australia, during 2002 to 2012.MethodsData from routine hospital and birth records were used to identify ECVs conducted at ≥36 weeks’ gestation. Women with ECV were compared to women who were potentially eligible for but did not have ECV. Eligibility for ECV was based on clinical guidelines. For those with ECV, birth outcomes following successful and unsuccessful procedures were examined.ResultsIn N = 32,321 singleton breech pregnancies, 10.5% had ECV, 22.3% were ineligible, and 67.2% were potentially eligible but did not undergo ECV. Compared to women who were eligible but who did not attempt ECV, those who had ECV were more likely to be older, multiparous, overseas-born, public patients at delivery, and to deliver in tertiary hospitals in urban areas (p < 0.01). Fewer women who underwent ECV smoked during pregnancy, fewer were morbidly obese, and fewer had a hypertensive disorder of pregnancy, compared to those who were eligible. Caesarean section occurred in 25.9% of successful compared to 95.6% of unsuccessful ECVs. Infant outcomes did not differ by ECV success.ConclusionsThe majority of women with a breech presentation did not receive ECV. It is unclear whether this is attributable to issues with service provision or low acceptability among women. Policies to improve access to and information about ECV appear necessary to improve uptake among women with term breech presentation. Improved data collection around the diagnosis of breech presentation, ECV attempts, and outcomes may help to identify specific barriers to ECV uptake.

Incidence, risk factors, and adverse short term perinatal and maternal outcomes associated with singleton breech presentation at delivery in Northern Tanzania

ABSTRACTBackgroundBreech presentation has been associated with adverse perinatal and maternal outcomes. However, the incidence and associated perinatal and maternal outcomes has not been fully explored in Tanzania. This study aimed to determine the incidence, risk factors and adverse short term perinatal and maternal outcomes associated with singleton breech presentation at delivery at Kilimanjaro Christian Medical Centre (KCMC) hospital.MethodsThis was a retrospective study involving 47,626 singletons deliveries between 2000 and 2014, using maternally-linked KCMC Medical Birth Registry. Adjusted odds ratios (ORs) with 95% CI for risk factors and adverse short term perinatal and maternal outcomes were estimated using multiple logistic regression models. ResultsThere were a total 8761 women who had subsequent singleton deliveries during this study period. The incidence of breech delivery was 0.8%. Advanced maternal age (&gt;30 years) (AOR 1.3 95% CI 1.1-1.6), delivery of low birth weight infant (AOR 3.4, 95% CI 2.8-4.1) and malformed child (AOR 8.0, 95% CI 3.6- 17.8) were associated with increased risk of breech delivery. Breech presentation was associated with an increased risk of delivering an infants with Apgar score of less than 7 at 5 minutes (AOR 4.6, 95% CI 3.7-5.6), low birth weight (AOR 3.5, 95% CI 2.9-4.3), congenital malformation (AOR 9.3, 95% CI 4.2-20.3) and perinatal death (AOR 6.3, 95% CI 5.1-7.9). Breech presentation was also associated with high risk of preeclampsia/eclampsia (AOR 1.6 95% CI 1.2-2.3) as compared to cephalic presentation. In addition, vaginal breech delivery increase women’s likelihood of delivering infant with Apgar score of less than 7 at 5 minutes (AOR 4.4, 95% CI 2.5-6.6), low birth weight (AOR 3.4, 95% CI 2.3-5.0) and perinatal death (AOR 5.1, 95% CI 3.1-8.4). ConclusionsBreech delivery was associated with adverse perinatal and maternal outcomes as compared to cephalic presentation. Vaginal breech delivery was associated with unfavorable perinatal and maternal outcomes as compared to cesarean breech delivery. Early identification of these risk factors and provision of appropriate management during delivery such as caesarian-section when needed may reduce the poor perinatal and maternal outcomes.

Amnioinfusion for women with a singleton breech presentation and a previous failed external cephalic version: a randomized controlled trial

Purpose: Our trial aimed to assess the effectiveness of amnioinfusion for a second attempt at external cephalic version (ECV). Material and methods: This open randomized controlled trial was planned with a sequential design. Women at a term ≥36 weeks of gestation with a singleton fetus in breech presentation and a first unsuccessful ECV were recruited in two level-3 maternity units. They were randomly allocated to transabdominal amnioinfusion with a 500-mL saline solution under ultrasound surveillance or no amnioinfusion before the second ECV attempt. Trained senior obstetricians performed all procedures. The primary outcome was the cephalic presentation rate at delivery. Analyses were conducted according to intention to treat (NCT00465712). Result: Recruitment difficulties led to stopping the trial after a 57-month period, 119 women were randomized: 59 allocated to amnioinfusion + ECV and 60 to ECV only. Data were analyzed without applying the sequential feature of the design. The rate of cephalic presentation at delivery did not differ significantly according to whether the second version attempt was or was not preceded by amnioinfusion (20 versus 12%, p = .20). Premature rupture of the membranes occurred for 15% of the women in the amnioinfusion group. Conclusion: Amnioinfusion before a second attempt to external version does not significantly increase the rate of cephalic presentation at delivery.

Remifentanil analgesia during external cephalic version for breech presentation in nulliparous women at term: A randomized controlled trial.

Background:The aim of the study was to assess the efficacy and safety of remifentanil for pain relief during external cephalic version (ECV) for breech presentation in nulliparous women at term.Methods:A total of 144 nulliparous women with singleton breech presentation were randomly divided into the intervention group and the placebo group, with 72 subjects in each group. The subjects in the intervention group received remifentanil (infused at 0.1 μg kg–1 min–1 with demand boluses of 0.1 μg/kg), whereas those in the placebo group were given saline placebo. This study was conducted from May 2013 to April 2016. The outcomes measures include pain (measured with the visual analog scale, VAS), success rate of ECV, maternal satisfaction for ECV, and adverse events.Results:A total of 137 participants completed the study. The intervention with remifentanil showed greater efficacy than did placebo in decreasing the VAS score immediately after ECV (intervention group 4.3 ± 2.2 vs placebo group 6.4 ± 2.5, P < 0.01). A significant difference in the ECV success rate was also found between the 2 groups (intervention group 56.9% vs placebo group 38.9%, P = 0.03). In addition, a significant difference in the satisfaction score was also detected (intervention group 9.3 ± 0.9 vs placebo group 6.7 ± 1.2, P < 0.01). The observed adverse events were similar between the 2 groups.Conclusion:This study shows that remifentanil could decrease pain, improve the ECV success rate, and improve satisfaction in nulliparous women at term during the period of ECV. Furthermore, it is also well tolerated with few adverse events.

Prevalence and Perinatal Outcomes of Singleton Term Breech Delivery in Wolisso Hospital, Oromia Region, Southern Ethiopia: A Cross-Sectional Study.

Background Breech deliveries have always been topical issues in obstetrics. Neonates undergoing term breech deliveries have long-term morbidity up to the school age irrespective of mode of delivery. Objective To determine prevalence and perinatal outcomes of singleton term breech delivery. Methods Hospital based cross-sectional study was conducted on 384 participants retrospectively. Descriptive and analytical statistics was used. Result A total of 384 breech deliveries were included. Prevalence of singleton breech deliveries in the hospital was 3.4%. The perinatal outcome of breech deliveries was 322 (83.9%). Adverse perinatal outcome of singleton term breech delivery was significantly associated with women's age of greater than or equal to 35 years (AOR = 2.62, 95% CI = 1.14–6.03), fully dilated cervix (AOR = 0.48, 95% CI = 0.25–0.91), ruptured membrane (AOR = 5.11, 95% CI = 2.25–11.6), and fetal weight of <2500 g (AOR = 6.77, 95% CI = 3.22–14.25). Conclusion Entrapment of head, birth asphyxia, and cord prolapse were the most common causes of perinatal mortality. Factors like fetal weight <2500 gm, mothers of age 35 years and above, those mothers not having a fully dilated cervix, and mothers with ruptured membrane were associated with increased perinatal mortality.

811: A retrospective assessment of delivery methods for breech singleton 22 - 26 6/7 week gestation

811: A retrospective assessment of delivery methods for breech singleton 22 - 26 6/7 week gestation

A randomized trial of remifentanil for analgesia in external cephalic version for breech presentation.

Background:Although external cephalic version (ECV) can be effective for correcting the fetus in a cephalic presentation, it may be painful for the mother. This study aimed to evaluate the efficacy and safety of remifentanil for pain relief during ECV in China.Methods:In all, 152 Chinese parturients with singleton breech presentation were randomly divided into 2 groups, each with 76 patients. All 152 patients were assigned to receive either remifentanil (infused at 0.1 μg/kg/min and demand boluses of 0.1 μg/kg) or saline placebo. The study was performed between January 2012 and December 2015. Outcome measurements included the Numerical Rating Pain Scale score (0–10) after ECV, success rate for ECV, and maternal satisfaction after ECV. Adverse events were also evaluated.Results:The study was completed by 146 patients. Remifentanil showed greater efficacy than placebo in decreasing the pain score immediately after ECV (remifentanil 4.6 ± 2.6 vs placebo 6.5 ± 2.7; P < 0.001). The success rate for ECV showed a significant difference between the 2 groups (remifentanil 56.5% vs placebo 39.5%; P = 0.04). Maternal satisfaction also showed a significant difference between the 2 groups (remifentanil 9.6 ± 1.4 vs placebo 6.4 ± 3.7; P < 0.001). However, the adverse events profiles were similar between both groups.Conclusion:The results of this study demonstrate that remifentanil is an effective intervention for reducing pain, achieving successful ECV, and increasing maternal satisfaction during ECV, and is generally well-tolerated without additional adverse effects.

The Risks of Planned Vaginal Breech Delivery Versus Planned Caesarean Section for Term Breech Birth: A Meta-Analysis Including Observational Studies

(BJOG. 2016;123:49–57) The optimal route of delivery for a term singleton breech presentation has been debated for &gt;50 years with several randomized and observational studies performed to address the question. The Term Breech Trial was a large, international study that showed decreased perinatal morbidity and mortality with cesarean section (CS). Following publication of this article in 2000, the American College of Obstetricians and Gynecologists and the Royal College of Obstetricians and Gynaecologists both recommended CS for term breech deliveries. A few years later, however, both organizations revised their recommendations to suggest a trial of labor in certain situations. Regardless, the vast majority of term breech presentations are now delivered by CS in high resource countries. The aim of this current meta-analysis was to establish the absolute and relative risks of planned vaginal breech delivery for term pregnancies.

Comparison of Perinatal Outcome of Breech Presentation between Vaginal Delivery and Cesarean Section

Introduction: Many times, parturient opt for labour and vaginal breech delivery even after informing increased perinatal risks. Vaginal breech deliveries are undertaken with the reasons like avoidance of cesarean section in next pregnancy, null risk of operative and anesthetic hazards, ability to resume early all household works after vaginal birth, etc. The purpose of this study is to compare the perinatal outcome of breech deliveries in singleton breech presentation between vaginal breech delivery and cesarean section.&#x0D; &#x0D; Methods: A retrospective study was done in Lumbini Medical College Teaching Hospital for the duration of one year (December 2014 to November 2015). Data of perinatal outcome of breech deliveries were collected from the hospital records. The records of neonatal examination were also collected. The primary outcomes included were neonatal morbidity and mortality.&#x0D; &#x0D; Results: Out of 80 selected women with breech presentation, 42 of them had vaginal deliveries and 38 women had undergone caesarean section. The perinatal mortality was 4.8% and morbidity was 2% in vaginal breech deliveries. There was no significant difference of APGAR score in the two groups at any time. Similarly, there was no significant difference in perinatal morbidity and mortality in the two groups. Nulliparous women were more likely to deliver by Cesarean section.&#x0D; &#x0D; Conclusion: In places where planned vaginal delivery is a common practice and when strict criteria are met before and during labour, planned vaginal breech delivery of singleton fetus in breech presentation remains a safe option that can be offered to women.

Outcomes of breech birth by mode of delivery: a population linkage study.

Trial evidence supports a policy of caesarean section for singleton breech presentations at term, but vaginal breech birth is considered a safe option for selected women. To provide recent Australian data on outcomes associated with intended mode of delivery for term breech singletons in women who meet conservative eligibility criteria for vaginal breech birth. Birth and hospital records from 2009 to 2012 in New South Wales were used to identify women with nonanomalous pregnancies who would be considered eligible for vaginal breech birth. Intended mode of delivery was inferred from labour onset and management. Of 10 133 women with term breech singleton pregnancies, 5197 (51.3%) were classified as eligible for vaginal breech delivery. Of these, 6.8% intended vaginal breech birth, 76.4% planned caesarean section and intention could not be determined for 16.8%. Women intending vaginal delivery had higher rates of neonatal morbidity (6.0% vs 2.1%), neonatal birth trauma (7.4% vs 0.9%), Apgar <4 at one minute (10.5% vs 1.1%), Apgar <7 at five minutes (4.3% vs 0.5%) and neonatal intensive care unit/special care nursery admissions (16.2% vs 6.6%) than those planning caesarean section. Increased perinatal risks remained after adjustment for maternal characteristics. Severe maternal morbidity (1.4% vs 0.7%) and post-partum readmission (4.6% vs 4.0%) were higher in the intended vaginal compared to planned caesarean births, but these differences were not statistically significant. In a population of women classified as being eligible for vaginal breech birth, intended vaginal delivery was associated with higher rates of neonatal morbidity than planned caesarean section.

Breech deliveries in a secondary health-care facility in South-South Nigeria

Context: The optimal mode of delivery for breech presentation remains an issue of debate among obstetricians. The care during labor, delivery methods used, and the skills of the birth attendant influence outcome of fetuses in breech presentation. Objectives: The objective of this study is to determine the incidence, mode of delivery, and outcome of singleton breech deliveries in a secondary health facility in South-South Nigeria. Materials and Methods: The case notes of all patients who had singleton breech delivery from January 1, 2009, to December 31, 2014, were studied. Data extracted were age, parity, booking status, mode of delivery, indication for cesarean section (CS), birth weight, Apgar score at 5 min and fetal outcome. The data were analyzed using SPSS Version 20 statistical package.P Results: There were 172 singleton breech deliveries and a total of 5736 deliveries during the study, giving an incidence of 3%. The mean age of the patients was 27 ± 5.4 years. About 36% of the patients were nulliparous, and over half (54.7%) of the patients were booked. About 55.2% of the patients had CS, most (67.4%) of whom were booked. The most common (26%) indication for CS was for breech presentation in primigravida. There were 122 live births (70.9%) and 50 stillbirths of which 36 (20.9%) were fresh stillbirths. The stillbirth rate was 290.7/1000 compared with 54/1000 births for singleton cephalic presentation for the same period. The mean birthweight was 2.96 ± 0.76 kg. Fetuses that weighed ≥3.5 kg had significantly poorer outcomes (P Conclusion: CS offers a better fetal outcome for singleton breech presentation and fetuses weighing ≥3.5 kg have a poorer outcome at delivery in our facility.

A 5-year retrospective review of singleton term breech deliveries seen at a tertiary hospital in northern Nigeria

Background: Most singleton breech deliveries in the developing countries are unplanned and therefore, associated with poor perinatal outcome. This is because despite high antenatal attendance, most patients present in advanced labour, coupled with inadequate work force and skill attendants for the management of such cases. This study was undertaken to determine the incidence and outcome of term singleton breech deliveries at the University of Maiduguri Teaching Hospital (UMTH). Patients and Methods: This is a retrospective study of term singleton breech deliveries at the UMTH, a tertiary health facility in northeastern Nigeria over 5 years from January 1, 2003 to December 31, 2007. The delivery and theater records for all singleton breech deliveries at term were collected while the case notes were retrieved from the central medical records department. Information on age, parity, booking status, type of breech, level of skill of the attendant (accoucheur), Apgar scores, and birth weight were extracted. The main outcome measures were still births, low Apgar scores, birth weight, and accoucheur. Data were analyzed using Statistical Package for the Social Sciences (SPSS) 16.0 statistical computer package. Results: There were 173 term singleton breech deliveries among the 10,203 patients who delivered during the study period, giving an institutional incidence of 1.69%. The age of the patients ranged 18-44 years; 51.9% of the patients were aged 25-34 years. The likelihood of breech presentation at term increased with increasing parity, being 25.5% among nulliparae, 34.4% in women with 2-4 children, and 40.1% in women who had delivered 5 or more children ( P = 0.001). Extended or Frank breech was the most common type of breech presentation, accounting for 54.8%. Most patients (80.3%) were booked. 52.2% were delivered by cesarean section (CS). Only 30.6% of the deliveries were planned despite the large proportion of booked patients in the study. There were 147 live births and two fresh stillbirths. Senior obstetricians or senior midwives were involved in the conduct of almost all the live births. The only two fresh still births resulted from the junior registrars' delivery. Birth asphyxia — Apgar score of less than 6-was more common in the unplanned group than in the planned group ( P = 0.01), and all instances were found in the patients delivered by junior registrars. Conclusion: Despite the high antenatal attendance in the study group, breech deliveries were largely unplanned and the fetal outcome was directly related to the level of skill of the accoucheur. There is a need to plan and have skilled and senior obstetricians in attendance at delivery for this high-risk group.

Prevalence and Perinatal Outcome of Singleton Term Breech Delivery in Mizan Aman General Hospital, South West, Ethiopia; A Three Year Retrospective Hospital based Study

Introduction: Breech deliveries have always been topical issues in obstetrics because of the very high perinatal mortality and morbidity. These are due to combination of trauma, birth asphyxia, prematurity and malformation. Neonates undergoing term breech deliveries have long-term morbidity up to the school age irrespective of mode of delivery. Objective: To determine the perinatal outcome of singleton term breech deliveries and identify associated factors at Mizan Aman General Hospital. Methods: Hospital based cross-sectional study was conducted. Data on Socio-demographic, obstetric conditions and outcome of singleton breech deliveries of all pregnant women was collected from January 01, 2012 to December 31, 2014 GC. The collected Data was entered to SPSS version-20 for analysis. Descriptive statistics was run and the association between independent and dependent variables was measured using logistic regression model and p-value < 0.05 statistically significant. Result: During the 3 years study period, a total of 126 singleton term breech deliveries were recorded out of 3729 deliveries giving the prevalence of singleton breech deliveries in the hospital to be 3.4%. The perinatal outcome of breech deliveries were 104(88%) born alive and 14(12%) were dead indicating that the perinatal mortality rate to be 120 per 1000 term breech presentations. The possible causes of death for dead delivered fetus were entrapment of head 5(35.7%), prolapsed cord 4(28.6%), birth asphyxia 3(21.4%) and intrauterine death with unknown cause 2(14.3%). Birth weight greater than 3500 gm have 26% chance of fetal loss when compared with fetal weight 2500-3499 gm. Vaginal breech delivery have significant statistical association with perinatal loss than abdominal route. Conclusion and Recommendation: Perinatal mortality rate, of 120 per 1000 breech deliveries. Which indicate that breech vaginal delivery is associated with an increased perinatal mortality and morbidity than caesarean delivery. Birth weight ≥ 3500 gm increase risk perinatal loss than fetal weight between 2500-3500 gm.

Outcomes of singleton and twin breech deliveries in a ten year (2005 to 2014) retrospective audit at two rural hospitals in Papua New Guinea’s Gulf Province

&lt;p&gt;&lt;span style="text-decoration: underline;"&gt;Introduction&lt;/span&gt;&lt;em&gt; &lt;/em&gt;The aim of this audit was to investigate the rates of breech-related perinatal death and maternal and neo-natal morbidity in a resource-poor setting where caesarean sections are difficult to perform. &lt;span style="text-decoration: underline;"&gt;Method&lt;/span&gt;&lt;em&gt;. &lt;/em&gt;An audit of 5,102 babies born at two rural Papua New Guinean hospitals, Kapuna and Kikori, from 2005 to 2014 inclusive was performed. Information was gathered from the facility obstetric registers and supplemented by Kikori Hospital’s surgical register. During the period there were 179 breech presentations (103 singletons, 76 twins). The primary outcome was defined as perinatal death. Secondary outcomes were neonatal morbidity and maternal post-partum haemorrhage. Exclusion criteria were applied prior to analysis. These included: Likely pre-labour intrauterine death; mother presenting to hospital in second or third stage; baby born before arrival at hospital; prematurity recorded in the notes or birth weight less than 1500g as a surrogate marker; significant fetal abnormality; and significant maternal medical condition. &lt;span style="text-decoration: underline;"&gt;Findings&lt;/span&gt;&lt;em&gt;. &lt;/em&gt;The adjusted incidence of the outcomes were: Perinatal death for vaginal breech singletons 235/1,000 (95% CI 158-336/1,000) and vaginal breech twins 31/1,000 (95% CI 9-107/1,000); neonatal morbidity for vaginal breech singletons 141/1,000 (95% CI 82-231/1,000) and vaginal breech twins 31/1,000 (95% CI 9-107/1,000); post-partum haemorrhage for vaginal breech singletons 129/1,000 (95% CI 74-217/1,000) and vaginal breech twins 230/1,000 (95% CI 137-361/1,000). &lt;span style="text-decoration: underline;"&gt;Conclusions&lt;/span&gt;&lt;em&gt;. &lt;/em&gt;Poor outcomes for singleton vaginal breech delivery at the two hospitals were common. The potential in the rural setting for increased education on safe trial of vaginal breach delivery as well as increasing access to caesarean sections deserves consideration. &lt;/p&gt;

VAGINAL BREECH DELIVERY

Objective: To determine the obstetric and perinatal outcome of pregnancieswith singleton breech presentation, and to scrutinize the causes of increasing incidence ofcesarean section in breech presentation. Design: Analytical Observational study. Place andduration: Department of obstetrics and gynecology Fatima hospital Baqai university campusfrom Jan 2010 to Oct 2011. Patients &amp; Methods: This study includes 135 patients with singletonbreech presentation ≥ 34 weeks of gestation, were analyzed in detail with help of designedperforma. Patients were categorized in three groups. Groups a, who had elective C-section,group b. who underwent emergency caesarean section or had C-section after failed trial ofvaginal delivery and group c. who had vaginal breech delivery. Elective caesarean section wasdone in those cases that had some other indications for carrying out this procedure apart frombreech presentation. Trial of vaginal breech delivery was planned for all multiparous womenexcept those falling in group A. All antepartum fetal demise, twin pregnancies and placentaprevia of major degree were excluded. Results: Of 135 women, 7(5%) underwent prelabourcesarean, and 128(95%), had trial of vaginal delivery, of whom 117(91.5%) delivered vaginally.Significantly more infants weighing&gt; 3.5kg were selected for prelabour and intrapartumcesarean than vaginal delivery. Two neonates had Apgar score&lt; 7 at 5 minutes but both werenormal neurologically. There were no nonanomalous perinatal death and no case of significanttrauma or neurological dysfunction. Two infants died due to lethal anomalies. Conclusion:Trial of vaginal breech delivery in well counselled patients, still taken as an appropriate optionwithout compromising prenatal and maternal outcome. It also decreases the rate of cesareansection.

Planned caesarean section for term breech delivery.

Planned caesarean section for term breech delivery.

Management of breech presentation at term: a retrospective cohort study of 10 years of experience.

To evaluate the impact of management of childbirth (external cephalic version (ECV) plus planned vaginal delivery (PVD)) of breech presentation at term (⩾37 weeks of gestation). This retrospective cohort study was based on data collected of singleton breech presentations at term in the Obstetrics and Gynaecology Service, Cruces University Hospital (Biscay, Spain), from January 2003 to December 2012. We attended 2377 singleton breech pregnancies at term. We attended 1684 singleton breech term deliveries, attempting vaginal delivery after selection in 52.9% of cases and were successful in 57.5% of attempts. A total of 1360 ECV were attempted, with a success rate of 50.3% of those attempted. The use of ECV has decreased the rate of breech presentation at delivery by 39.0%, the rate of breech presentation as a caesarean section (CS) indication by 47.1% (CS due to breech presentation/total of CS) and the rate of CS for breech presentation out of the total of deliveries by 39.1% (CS due to breech presentation/total of deliveries). Early postnatal parameters (5-min Apgar score, umbilical cord arterial pH and acid-base analysis) were significantly lower following PVD compared with planned CS for breech presentation. However, we did not find any differences in the rates of admissions to the neonatal unit or neonatal mortality. Management of breech presentation with a protocol that includes ECV, careful selection criteria and active management of vaginal delivery achieve a great decrease in the rate of CS for breech presentation.