Type Of Breech Research Articles

External Cephalic Version: A Retrospective Chart Review at a Canadian Tertiary Care Centre

ObjectivesThe primary objective is to identify our local external cephalic version (ECV) success rate, variables associated with increased likelihood of success, and complication rates. The secondary objective is to allow obstetrical care providers to accurately counsel patients undergoing a trial of ECV. MethodsWe analysed patient charts between January 2018 and December 2022 who underwent ECV. Variables included maternal age, parity, gestational age at the time of ECV attempt, breech type, anesthetic, uterine relaxant, placental location, neonatal birthweight, and provider seniority. Outcomes were ECV success, mode of delivery, emergent cesarean delivery rate due to ECV, and neonatal intensive care unit admission. Appropriate statistical analysis was performed. ResultsOverall, 258 patients were included. Overall success rate was 31%. Multiparity, transverse presentation, and neonatal birthweight >3.3 kg were associated with significantly increased success rates. Uterine relaxant use was associated with a lower success rate than no relaxant use, which is potentially explained by significantly more frequent relaxant use in non-transverse presentations and a non-significant trend in increased relaxant use in primiparous patients. Other factors including anesthetic use, maternal age, gestational age, placental location, and provider seniority did not significantly impact success. The emergency cesarean delivery rate was 10% and the neonatal intensive care unit admission rate was 8%, both of which were higher than anticipated. ConclusionsECV remains an option for the management of the term breech. Obstetrical providers at our centre and in others may use this study to more accurately counsel patients using local data and optimize the likelihood of success based on patient and peri-procedural factors.

A prospective study using an individualized nomogram to predict the success rate of external cephalic version

To establish a clinical-based nomogram for predicting the success rate of external cephalic version (ECV) through a prospective study. This was a single-center prospective study that collected eligible breech pregnant women. 152 participants were enrolled in the training cohort, who received ECV procedures performed by a single operator. We used the training cohort to establish regression equations and prediction models. These variables include maternal factors (age, operation gestational age, pre-pregnancy BMI (Body Mass Index), operation BMI, BMI increase, multipara), ultrasound factors (fetal weight estimation, amniotic fluid index, placental location, type of breech presentation, spinal position), and anesthesia. Univariate and multivariable analyses were used to screen the factors affecting the success of ECV. A nomogram scoring model was established based on these factors. And C-index, DCA (Decision Curve Analysis) and calibration curve, Hosmer–Lemeshow test was used to verify the prediction effect of the model. Finally, 33 participants were enrolled in the testing cohort who received ECV with an unrestricted operator. We used C-index, DCA (decision curve analysis), and Hosmer–Lemeshow to verify the application value of the prediction model. The calibration curves and ROC curves of both the training cohort and testing cohort are plotted for internal and external validation of the model. The ECV success rate of the training cohort was 62.5%. Univariate analysis showed that the predictors related to the success rate of ECV were age, BMI increase value, AFI (amniotic fluid index), breech type, placental location, spinal position, anesthesia, and multipara. The prediction thresholds of the corresponding indexes were calculated according to the Youden index. Multivariate logistic regression analysis showed that BMI increase ≥ 3.85 kg/m2, AFI ≥ 10.6 cm, anesthesia, multipara, and non-anterior placenta were independent predictors of ECV success. Through the internal and external validation, it is confirmed that the model has a good calibration and prediction ability. Our nomogram has a good ability to predict the success rate of ECV.

Analysis of spontaneous labor progression of breech presentation at term.

Cervical dilatation curves are widely used to describe normal and abnormal labor progression for cephalic presentation. Labor curves for breech presentations have never been described. The aims of this study were to examine the pattern of labor progression in women with a breech presentation and to determine whether the type of breech or parity can influence the speed of cervical dilatation. We analyzed the labor data from 349 women with a term, singleton, and breech fetus after spontaneous onset of labor in 2010-2018. Cesarean deliveries were excluded. The patterns of labor progression were described by examining the relationship between the elapsed times from the full dilatation and cervical dilatation stages. Average labor curves were developed using repeated-measures analysis with 3rd degree polynomial modeling. The results were interpreted according to parity and the type of breech. The first stage of labor progression was divided into a latency phase from 0 to 5 cm of dilatation and an active phase from 5 to 10 cm. In the active phase, the median speed of cervical dilatation was 1.67 cm/h [1.25, 2.61] (2 cm/h for multipara and 1.54 cm/h for nullipara). The difference by parity was significant in the active phase (p< 0.05). The cervical dilatation rate from 3 cm to 10 cm did not significantly differ between the complete and frank breeches (1.56 cm/h vs 1.75 cm/h, p = 0.48). However, the median cervical dilatation rate from 8 cm to complete dilatation was faster for complete breeches (1.92 cm/h versus 1.33 cm/h, p = 0.045). As with cephalic presentation, the first stage of labor progression for breech presentation can be divided into a latent and active phase. Labor progression should be interpreted with respect to parity, and women should be informed that the type of breech does not seem to influence the cervical dilatation rate when there is adequate management.

391. Analysis of spontaneous labor progression of breech presentation at term

Introduction: Cervical dilatation curves are widely used to describe normal and abnormal labor progression for cephalic presentation. Labor curves for breech presentations have never been described. The aim of this study was to examine the pattern of labor progression in parturient with a breech presentation and to determine if the type of breech or parity could influence the speed of cervical dilatation. Study design: We analyzed labor data from 349 women with a term, singleton, and breech fetus after spontaneous onset of labor in 2010 – 2018.

To determine the rate of success of external cephalic version in low risk breech presentations and possible factors affecting its success in POF hospital, Wah Cantt.

Abstract&#x0D; &#x0D; Background&#x0D; The caesarean section rate is on the rise for various reasons. One of the reason is breech presentation . External cephalic version is a procedure to manipulate the baby from breech to cephalic presentation externally through the maternal abdomen under USG guidance . Success in ECV decreases the breech presentation and hence caesarean section rate .&#x0D; Methods&#x0D; This retrospective study was conducted by Wah Medical College in POF hospital from10 Oct 2015- 10 Oct 2019 after approval from the ethical committee .&#x0D; It included 56 low risk singleton breech presentations from 36 wks- 40 wks after taking their informed consent While those with &lt; than 36 wks (primis) and &gt;40 wks gestation, refusal to ECV , with absolute contraindication to ECV&amp; with medical and obstetric complications (ie scarred uterus, liquor &lt;than 8 cm &amp; &gt; than 17 cm, fetal growth restriction, preclampsia, gestational diabetes &amp; abnormal cardiotocography) were excluded from the study. ECV was performed by single obstetrician in labour room with facilities of cardiotocograph and emergency caesarean section. Cardiotocography of the fetus for 30-40 min was done just before &amp; after the procedure of ECV. ECV was declared successful on cofirming head of the fetus occupying the lower uterine segment on ultrasound. .Number of successful ECVs &amp; specific factors of the women &amp; the baby (age . parity, amniotic fluid index ,type of breech, engagement of breech, position of back of baby) were chosen to observe their effect on success of ECV.&#x0D; Results&#x0D; External cephalic version was successful in 27 (48.2%) &amp; unsuccessful in 29 (51.8%)of women .Multiparity , unengaged breech &amp; type of breech (complete flexed) ( with p values .001, .000 &amp; .001 respectively) had statistically significant positive association with successful external cephalic version.&#x0D; Conclusion&#x0D; ECV should be offered to all women with low risk breech presentations. Knowledge of factors predictive of ECV success can be utilized in selecting cases for ECV &amp;counselling the women regarding the success and failure of ECV.&#x0D; &#x0D;

Type of breech presentation and prognosis for delivery

BackgroundAlthough its role in the prognosis for delivery remains controversial, the type of breech is sometimes taken into account in the decision about mode of delivery. Objective of our study was to compare maternal and neonatal morbidity for trial of vaginal delivery according to the type of breech (complete or frank). Material and methodSingle-center retrospective study of women with trials of vaginal delivery of a singleton fetus in breech presentation at of after 37 weeks of gestation. Neonatal status was assessed by the composite variable of the Term Breech Trial, first considered alone, and then with the addition of a 5-min Apgar score < 7 or a neonatal arterial pH<7.0. ResultsOf the 495 trials of vaginal delivery during the study period, approximately one third of them were complete breech (35.8 %) and two thirds frank (64.2 %). The frequency of cesareans during labor was similar regardless of the type of breech (16.4 for complete vs 12.6 % for frank, p=0.24), nor did neonatal morbidity differ (1.7 for complete vs 4.1 % for frank, p=0.15). On the other hand, cord prolapse occurred almost exclusively in complete breech presentations (4.5 vs 0.3 %, p<0.01), and prognosis was good in all cases. Complete breech presentations were also associated with more frequent use of forceps to the after-coming head (16.2 vs 9.7 %, p<0.05). Finally, there were non significant difference between the two types of breech concerning severe acidosis but it seemed to have it more in frank breech (2.3 vs 1.2 %, p=0.34). ConclusionAmong women eligible for vaginal delivery, the type of breech presentation (complete or frank) has little influence on delivery maternal and neonatal morbidity. The type of breech need not be taken into account in deciding the route of delivery.

Study on feto-maternal outcome in term singleton pregnancies with breech presentation at tertiary care centre, Jodhpur

Background: Breech presentation is a longitudinal lie of the foetus with the caudal pole occupying the lower part of the uterus and cephalic pole in the uterine fundus. The prevalence of term breech presentation varies globally. Breech presentation and delivery have been classified as high risk because of the increased incidence of perinatal and maternal complications. Comprehensive obstetric care and intensive neonatal care play a crucial role to decrease complications related to breech delivery. Objective: To evaluate feto-maternal outcome including mode of delivery in term singleton pregnancies with breech presentation. Material and Methods: An observational study was conducted on all pregnant women with term singleton breech presentation. A rapid assessment was made to establish the stage of labor, status of membrane and condition of the foetus. Close surveillance of foetal heart rate and uterine contraction was monitored. Vaginal examination was done to know the state and dilation of cervix, type of breech and its status. Status of membranes and the pelvis with assessment of fetopelvic disproportion. Results: The incidence of term breech delivery was 3.63%. The most common complication in term breech presentation was contracted pelvis (6%). The incidence of perinatal morbidity was 9% with maximum case of birth asphyxia (5%). The incidence of perinatal mortality was 8.48% among that in multigravidia parity it was 7.4% and in primigravidia it was 1.08%. Conclusion: It is concluded that the balanced decision about the mode of delivery on a case by case basis as well as conduct, training and regular drills of assisted breech delivery will go a long way to optimize the outcome of breech presentation.

Development and validation of a clinical score to predict the probability of successful procedure in women undergoing external cephalic version

Introduction External Cephalic Version (ECV) reduces breech presentation at term and thus contribute to the reduction of cesarean section. This study was done to determine the factors associated with the successful ECV in women with breech presentation after 36 weeks’ gestation and also to develop and validate a clinical score which could be utilized for individual patient counseling in future. Methods This was a retrospective cohort study conducted in a tertiary care center and teaching hospital in south India. Prospectively collected data from the register maintained for all ECVs performed on pregnant women with breech presentation at or more than 36 weeks’ gestation. Clinical and ultrasound parameters at the time of performing the procedure were used in the analysis. Multiple logistic regression with a stepwise backward selection procedure was used selecting potential variable to construct the model and internal validation was done with bootstrapping. Primary outcome was successful ECV defined as cephalic presentation at the end of the procedure Results Among 611 women who underwent ECV, it was successful in 70.4%. In the multiple logistic regression model, multiparity (OR4.48), AFI ≥ 7 (OR = 3.06), type of breech, posterior placental location (OR = 1.57), sacro-anterior position of breech (OR = 2.83), normal uterine tone (OR = 1.82) and fetal pole not engaged (OR = 2.82) were found to be predictive of successful ECV with good discrimination (AUC = 0.782) and acceptable calibration. Combining these factors from the model a predictive score (score 0–13) is proposed for clinical utility. Conclusions Combining clinical and ultrasound parameters into a predictive score, which is simple and effective, could be utilized in the clinical practice, once validated externally.

Success rate and influencing factors of external cephalic version for singleton pregnancies in the third trimester

Objective: To investigate the factors associated with the success rate of external cephalic version (ECV) for singleton and non-cephalic presentation pregnancies in the third trimester. Methods: A retrospective study of ECV among singleton and non-cephalic presentation pregnant women in 36-40 weeks of gestation at Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region from January 2016 to June 2018 was analyzed. Results: (1) Totally, 251 cases of 358 pregnant women who underwent ECV were successful, with a total success rate of 70.1% (251/358). The success rate of multipara was 79.1% (129/163), while 62.6% (122/195) in primipara (P<0.01). The total vaginal delivery rate was 52.2% (187/358), the vaginal delivery rate of multipara was 61.3% (100/163), while 44.6% (87/195) in primipara (P<0.01). (2) Spontaneous reversion occurred in 7.6%(19/251) of ECV successful women, the rate of reversion of multipara was 10.9% (14/129), higher than that of the primipara [4.1% (5/122); P<0.01]. (3) Among the 232 pregnant women who did not reverted after successful ECV, 187 cases of successful vaginal delivery, the vaginal delivery rate was 80.6% (187/232); the vaginal delivery rate of the multipara was 87.0%(100/115), which was higher than that of the primipara [74.4%(87/117); P<0.01]. (4) The variables significantly associated with ECV success were parity, type of breech, whether fetal presentation was in pelvic or not (all P<0.05). The complication rate was 2.2% (8/358), among which the incidence of fetal distress, placental abruption and transient fetal heart abnormalities were 0.6% (2/358), 0.3% (1/358) and 1.4% (5/358) respectively. Conclusion: By close monitoring, ECV is a safe and effective procedure in selected appropriate cases, and worthy of clinical application.

Feto-maternal outcomes of term assisted breech deliveries at the University Teaching Hospital, Lusaka, Zambia

ackground: Breech presentation occurs when the fetus presents with buttocks or feet first. Globally, the incidence of breech is 3-4% at term. The safest mode of delivery for most breeches at term is still controversial despite extensive research. The aim of this study was to determine the feto-maternal outcomes of assisted term breech deliveries at the University Teaching Hospital (UTH).&#x0D; Methods: A cross sectional study was conducted in 73 pregnant women with term breech admitted to the labor ward that delivered vaginally. Data was collected by administering a structured questionnaire and from medical records. The Pearson's chi-squared test was used for comparison of proportions between groups. One multivariate logistic regression was used to determine associations with neonatal intensive care unit (NICU) admission and also a second one associations with type of breech.&#x0D; Results: The mean age of the participants was 30.6 ± 5.5 (range 18-41) years. The mean gestational age at delivery was 38.6 weeks and mean parity was 3.4, with a 5% history of previous breech. The average levels of asphyxia measured by Apgar score were 7.1 at 1 minute, 8.1 at 5 minutes and 8.6 at 10 minutes. The average fetal weight was 3200g, with 10% admissions to Neonatal intensive care unit (NICU). For the maternal outcomes, one participant had postpartum haemorrhage (PPH), and one participant had an episiotomy and none had symphysiotomy. On multivariate analysis, NICU admission was associated with lower Apgar score at 1 minute. Babies that were not admitted to NICU had 90% reduced odds for low Apgar score &lt; 7 [Adjusted Odds Ratio (OR) = 0.10, 95% Confidence Interval (CI) = 0.004 – 0.24, P value &lt; 0.01. Also, on multivariate analysis, type of breech was associated with lower Agpar score at 5 minutes. Compared to footling breech, patients with extended breech had 97% reduced odds for low Apgar score &lt; 7 (OR 0.03, 95% CI 0.004 – 0.22, p-value &lt; 0.01). Patients with complete breech had 85% reduced odds for lower Apgar score &lt; 7 (OR 0.15, 95% CI 0.05 – 0.44, pvalue &lt; 0.01).&#x0D; Discussion and Conclusion: Feto-maternal outcomes of assisted term vaginal breech deliveries at UTH were favourable with low levels of asphyxia, neonatal admissions to NICU, and need for blood transfusion. Therefore, breech vaginal delivery at term may still be a viable option at UTH as demonstrated by this study.

Feto-Maternal Outcomes of Term Assisted Breech Deliveries at the University Teaching Hospital, Lusaka, Zambia

Background: Breech presentation occurs when the fetus presents with buttocks or feet first. Globally, the incidence of breech is 3-4% at term. The safest mode of delivery for most breeches at term is still controversial despite extensive research. The aim of this study was to determine the feto-maternal outcomes of assisted term breech deliveries at the University Teaching Hospital (UTH).&#x0D; Methods: A cross sectional study was conducted in 73 pregnant women with term breech admitted to the labor ward that delivered vaginally. Data was collected by administering a structured questionnaire and from medical records. The Pearson's chi-squared test was used for comparison of proportions between groups. One multivariate logistic regression was used to determine associations with neonatal intensive care unit (NICU) admission and also a second one associations with type of breech.&#x0D; Results: The mean age of the participants was 30.6 ±&#x0D; 5.5 (range 18-41) years. The mean gestational age at delivery was 38.6 weeks and mean parity was 3.4, with a 5% history of previous breech. The average levels of asphyxia measured by Apgar score were 7.1 at 1 minute, 8.1 at 5 minutes and 8.6 at 10 minutes. &#x0D; The average fetal weight was 3200g, with 10% admissions to Neonatal intensive care unit(NICU). For the maternal outcomes, one participant had post- partum haemorrhage (PPH), and one participant had an episiotomy and none had symphysiotomy.&#x0D; On multivariate analysis, NICU admission was associated with lower Apgar score at 1 minute. Babies that were not admitted to NICU had 90% reduced odds for low Apgar score &lt; 7 [Adjusted Odds Ratio (OR) = 0.10, 95% Confidence Interval (CI) = 0.004 – 0.24, P-value &lt; 0.01. Also, on&#x0D; multivariate analysis, type of breech was associated with lower Agpar score at 5 minutes. Compared to footling breech, patients with extended breech had 97% reduced odds for low Apgar score &lt; 7 (OR 0.03, 95% CI 0.004 – 0.22, p-value &lt; 0.01). Patients with complete breech had 85% reduced odds for lower Apgar score &lt; 7 (OR 0.15, 95% CI 0.05 – 0.44, p-&#x0D; value &lt; 0.01).&#x0D; Discussion and Conclusion: Feto-maternal outcomes of assisted term vaginal breech deliveries at UTH were favourable with low levels of asphyxia, neonatal admissions to NICU, and need for blood transfusion. Therefore, breech vaginal delivery at term may still be a viable option at UTH as demonstrated by this study.

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.

Ultrasonographic Evaluation of Myometrial Thickness and Prediction of a Successful External Cephalic Version

To test the hypothesis that myometrial thickness predicts the success of external cephalic version. Abdominal ultrasonographic scans were performed in 114 consecutive pregnant women with breech singletons before an external cephalic version maneuver. Myometrial thickness was measured by a standardized protocol at three sites: the lower segment, midanterior wall, and the fundal uterine wall. Independent variables analyzed in conjunction with myometrial thickness were: maternal age, parity, body mass index, abdominal wall thickness, estimated fetal weight, amniotic fluid index, placental thickness and location, fetal spine position, breech type, and delivery outcomes such as final mode of delivery and birth weight. Successful version was associated with a thicker ultrasonographic fundal myometrium (unsuccessful: 6.7 [5.5-8.4] compared with successful: 7.4 [6.6-9.7] mm, P=.037). Multivariate regression analysis showed that increased fundal myometrial thickness, high amniotic fluid index, and nonfrank breech presentation were the strongest independent predictors of external cephalic version success (P<.001). A fundal myometrial thickness greater than 6.75 mm and an amniotic fluid index greater than 12 cm were each associated with successful external cephalic versions (fundal myometrial thickness: odds ratio [OR] 2.4, 95% confidence interval [CI] 1.1-5.2, P=.029; amniotic fluid index: OR 2.8, 95% CI 1.3-6.0, P=.008). Combining the two variables resulted in an absolute risk reduction for a failed version of 27.6% (95% CI 7.1-48.1) and a number needed to treat of four (95% CI 2.1-14.2). Fundal myometrial thickness and amniotic fluid index contribute to success of external cephalic version and their evaluation can be easily incorporated in algorithms before the procedure. III.

A prospective study of the factors associated with the success rate of external cephalic version for breech presentation at term

Objective To determine the factors associated with the success rate of external cephalic version (ECV) for breech presentation at term. Methods A prospective analysis of 500 ECV maneuvers. The variables maternal age, maternal weight, body mass index, previous cesarean delivery, gestational age, parity, amount of amniotic fluid, placental location, and type of breech were studied using logistic regression analysis. Results The success rate of ECV was 52.2% (n = 261). The variables significantly associated with success were parity, placental location, amount of amniotic fluid, and type of breech ( P < 0.05). A parity of 2 had a 3.74-times higher probability of success than nulliparity (95% CI, 2.37–5.90); a posterior placenta increased the success rate by 2.85 times compared with an anterior placenta (95% CI, 1.87–4.36); and double footling breech presentation had a 2.77-times higher success rate compared with a frank breech presentation (95% CI, 1.16–6.62). The area under the ROC curve showed a predictive ability of 73.6% (95% CI, 69.2%–77.9%) for these 3 variables. Conclusion Parity, placental location, amount of amniotic fluid, and type of breech presentation were associated with the success rate of ECV.

Employing nifedipine as a tocolytic agent prior to external cephalic version

External cephalic version (ECV) is accepted as a means of reducing the rate of breech presentation at term. Routine use of tocolysis prior to an ECV has been described to increase its success rate. The study's objective was to evaluate the efficacy of oral nifedipine as a tocolytic agent prior to ECV, and to compare it with intravenous ritodrine (IR). Women with breech presentation at term considered suitable for ECV were given nifedipine prior to the procedure. The success rate was compared to a cohort of women who underwent an ECV attempt at our department during the years 1999-2002 using IR prior to the procedure. Power analysis indicated that 70 women were needed in each group to detect a difference of 25% from our baseline success rate of 50%. Seventy-six women receiving nifedipine before their ECV attempt were compared to 90 women who received IR. Age, parity, gestational age at ECV, type of breech, placental location, fetal weight, and gestational age at delivery were not different between the groups. The overall success rate was 54% and 50% in the nifedipine and ritodrine groups respectively (p=0.6). The success rate among primiparous women was 35% and 29% respectively (p=0.8). The success rate among multiparous women was 64% and 63% respectively (p=1.0). The success rate was statistically different between primiparous and multiparous women in each group (p<0.05). Oral nifedipine may be as effective as IR when administered before ECV.

Undiagnosed term breech: Impact on mode of delivery and neonatal outcome

Background. The purpose of this study was to compare delivery mode and neonatal outcome in breech pregnancies diagnosed antepartum (Dx group) with those diagnosed on admission for delivery or intrapartum (No-Dx group). Methods. During an 11-year period, breech pregnancies ≥34 weeks' gestation with a live nonanomalous fetus were reviewed. The Dx group was matched for gestational age, parity, and maternal age to the No-Dx group (n = 256) and compared using the χ2-test, the Mc-Nemar test, and the Wilcoxon rank test. A p-value of < 0.05 was considered significant. Results. Breech type and birthweights were similar in the two groups. In the No-Dx group, 19.5% did not receive prenatal care. More patients in the No-Dx group were admitted with cervical dilation > 4 cm (39.4% vs. 27.0%, p = 0.004), whereas 17.1% of patients in the Dx group were admitted for elective cesarean delivery at term. There was a higher cesarean delivery rate in the Dx group (64.1% vs. 50.8%, p = 0.003), specifically for arrest disorders (15.2% vs. 6.9%, p = 0.008). The neonatal outcome in the two groups was similar regarding Apgar scores, intensive care nursery admission, need for mechanical ventilation, neonatal death, and length of nursery stay. Conclusions. Antepartum diagnosis of breech presentation decreases the threshold for cesarean delivery. Failure to diagnose breech antepartum does not compromise neonatal outcome.

External Cephalic Version

In Brief Objective To evaluate predictive variables for successful external cephalic version. Methods During 1987–1996, 128 women had external cephalic version attempts. Uterine tone, fetal spine position, breech location, breech type, gestational age, placental location, parity, maternal weight, amniotic fluid index, and estimated fetal weight were evaluated as predictors of success. Results Seventy-eight (64%) women were successfully converted from breech to vertex presentation. All subjects with low uterine tone had successful version. In women with high uterine tone, the combination of anterior or lateral fetal spine, noncornual placental location, and breech location out of the pelvis predicted success. Other independent variables associated with successful version included non-frank breech presentation, gestational age under 38 weeks, and parity of at least 1. Conclusion Uterine tone may be the most important predictor of success when selecting candidates for external cephalic version. Uterine tone is an important predictor of successful external cephalic version.

External cephalic version: predictors of success

Objective: To evaluate predictive variables for successful external cephalic version. Methods: During 1987–1996, 128 women had external cephalic version attempts. Uterine tone, fetal spine position, breech location, breech type, gestational age, placental location, parity, maternal weight, amniotic fluid index, and estimated fetal weight were evaluated as predictors of success. Results: Seventy-eight (64%) women were successfully converted from breech to vertex presentation. All subjects with low uterine tone had successful version. In women with high uterine tone, the combination of anterior or lateral fetal spine, noncornual placental location, and breech location out of the pelvis predicted success. Other independent variables associated with successful version included nonfrank breech presentation, gestational age under 38 weeks, and parity of at least 1. Conclusion: Uterine tone may be the most important predictor of success when selecting candidates for external cephalic version.

Undiagnosed breech revisited

To study the incidence of undiagnosed breech and to compare the obstetric outcome with those diagnosed before the onset of labour in a local teaching hospital where external cephalic version at term is routinely offered. A retrospective casenote analysis. Tsan Yuk Hospital, a teaching hospital in Hong Kong. One hundred and thirty-one women with a singleton breech presentation at term, delivered in a local teaching hospital from 1 January 1997 to 31 December 1997. The group of 22 women who had successful external cephalic version performed was included. Breech presentation was diagnosed at the antenatal clinic in 103 women (79%). In the remaining 28 women (21%), breech presentation was diagnosed for the first time after the onset of labour. Undiagnosed breech presentations were more likely to deliver vaginally (42%) than those diagnosed at the antenatal clinic (11%) (P < 0.001). Vaginal delivery was still more common in the undiagnosed group (46%) than the diagnosed group (26%), even when the group with successful external cephalic version was included (P < 0.05), although the difference became less obvious. The demographic characteristics, birthweight, type of breech and short term neonatal outcomes were comparable between the two groups. It is important to include women who had successful external cephalic version when comparing the obstetric outcome of undiagnosed and diagnosed breeches. Careful assessment for vaginal delivery is still very useful even when breech presentations are first diagnosed after the onset of labour because the infants are even more likely to deliver vaginally with no great excess of neonatal morbidity.

Establishing an external cephalic version clinic: outcome of the first year

The effect of introducing an external cephalic version (ECV) clinic was evaluated after 12 months. The practical procedure of establishing the clinic, its protocol and the technique of ECV is described. All women had singleton pregnancies of at least 36 weeks gestation. There were 61 'primary' attempts at ECV, and one repeat attempt. The operator performing the majority of the ECVs had a 56% success rate, whilst the overall rate for the clinic was 53%. There was minimal fetal and maternal morbidity. Success according to placental site, parity, gestation and type of breech as well as the mode of delivery and neonatal outcome of all patients on whom ECV was attempted is presented. There was a significant decrease in the total number of breech deliveries, mainly through a 60% reduction in emergency caesarean section. The cost effectiveness of the clinic and the use of tocolytics is discussed.