To evaluate the association of vaginal versus caesarean birth with neonatal and maternal outcomes for breech, singleton deliveries at 22 0/7 to 25 6/7 weeks of gestation. Retrospective cohort study. Hospital births in the United States. This study analysed non-anomalous, singleton, breech live births at 22 0/7 to 25 6/7 weeks of gestation identified in the linked birth-infant death records data from 2016 to 2021. A propensity score analysis was conducted to establish pseudo-randomization based on the mode of delivery, matching vaginal to caesarean deliveries at a ratio of 1:2 using greedy nearest-neighbour matching. The propensity score estimation included year of delivery, maternal age, race/ethnicity, pre-pregnancy body mass index, parity, marital status, maternal education, insurance status, attendant at delivery, smoking status, hypertensive disorders, diabetes mellitus, gestational age, induction of labour and whether a trial of labour was attempted. We estimated the risk differences (RD) and odds ratios (OR) and associated 95% CIs, taking the matching into consideration. Multiple imputation was used to account for missing data. Composite adverse neonatal and maternal outcomes. Of 21,461 periviable breech singleton births, 34.0% (n = 7289) were delivered vaginally. The median gestational age was 24 (IQR: 23-25) and 23 (IQR: 22-24) weeks in the vaginal and caesarean delivery groups, respectively. Earlier gestational age was associated with vaginal birth, while later gestational age was associated with caesarean births. After propensity score matching, the distributions of baseline factors, except for gestational age, were balanced between the vaginal and caesarean delivery groups. A composite of adverse neonatal outcomes occurred among 99.0% (n = 7213) of vaginal and 96.8% (n = 13,716) of caesarean breech births (aRD 1.8%, 95% CI 1.3 to 2.4; aOR 2.25, 95% CI 1.59 to 3.17). Neonatal mortality rates were higher among vaginal compared to caesarean breech births (72.6% versus 36.2%; aRD 26.8%, 95% CI 25.0 to 28.6; aOR 3.15, 95% CI 2.85 to 3.48). A composite of adverse maternal outcomes occurred in 1.6% of vaginal breech and 3.1% of caesarean births (aRD -1.7%, 95% CI -2.2 to -1.1; aOR 0.47, 95% CI 0.35 to 0.63). Vaginal breech birth between 22 0/7 and 25 6/7 weeks of gestation is associated with a lower risk of adverse maternal outcomes but a higher risk of neonatal adverse outcomes and mortality.

Guidelines on vaginal breech delivery have several restrictions concerning feto-maternal parameters. To date, they neglect the impact of prenatal pelvimetry, especially of the intertuberous distance (ITD), in nulliparous women attempting vaginal breech birth. We performed a prospective cohort study involving 876 nulliparous women with a breech presentation at term, analyzing the impact of the ITD measured with magnetic resonance imaging (MRI) imaging prior to delivery on maternal and fetal short-term outcome parameters, as well as the necessity for manual assistance during vaginal breech delivery. Bivariate linear and nominal regression as well as multivariate adjusted nominal-logistic regression with Walds-testing was performed. We found a significant negative correlation between the ITD and fetal short-term morbidity (odds ratio [OR] per cm 0.56, 95% confidence interval [CI]: 0.31-0.98, P = 0.048). Significance was not reached when excluding deliveries with an ITD of below 11 cm. Multivariate adjusted regression showed a significant correlation of cesarean section and ITD (OR 0.72, 95% CI: 0.62-0.85, P < 0.001). In a multivariate subcohort analysis of all vaginal deliveries, the ITD was significantly associated with assisted head delivery (OR 0.67, 95% CI: 0.54-0.83, P < 0.001) and fetal short-term morbidity (OR 0.44, 95% CI: 0.20-0.90, P = 0.031) when adjusted to fetal birth weight, head circumference and the obstetrical conjugate (OC). When cases with an ITD of below 11.5 cm were excluded, no significant association of the ITD and fetal short-term morbidity was detected. Prenatal pelvimetry in breech presentation at term can be used to select patients for vaginal birth attempts. Women with an intertuberous distance (ITD) of below 11 cm might benefit from a cesarean section recommendation.

IntroductionMagnetic resonance (MR) pelvimetry is widely used in planning vaginal breech birth and may support women's informed decision‐making regarding their preferred mode of birth. This feasibility study aimed to assess whether transperineal ultrasound (TPU) could measure the maternal pelvis as accurately as MR pelvimetry and thus predict the outcome of vaginal breech birth.Material and MethodsIn this prospective cohort study, nulliparous women with a singleton fetus in breech presentation received TPU for the measurement of the anteroposterior mid‐pelvic diameter (AMD). These measurements were compared with those in MR pelvimetry to assess agreement and reliability. In women choosing to attempt vaginal breech birth, we additionally examined the association between the AMD (adjusted for possible confounders) and intrapartum cesarean section. The predictive performance of the AMD and traditional pelvic diameters (i.e., obstetric conjugate, interspinous, and intertuberous distance) was compared by means of the area under the receiver operating characteristic curve (AUC).ResultsOverall, 67 nulliparous women with breech presentation received both TPU and MR pelvimetry, of which 47 chose a vaginal breech birth (30 successful vaginal births and 17 intrapartum cesarean sections). The repeatability coefficients and intraclass correlation coefficient for the AMD were 0.38 cm and 0.97 (95% CI 0.96–0.98), respectively. Bland–Altman analysis between the AMD measured in TPU and MR pelvimetry yielded a mean difference of −0.0052 cm (95% CI −0.066 to 0.056 cm) with upper and lower limits of agreement of 0.48 cm (95% CI 0.38–0.59 cm) and −0.49 cm (95% CI −0.6 cm to −0.39 cm), respectively. In the subgroup of women who attempted vaginal breech birth, AMD was significantly associated with intrapartum cesarean section (adjusted odds ratio 0.25; 95% CI 0.06–0.81; AUC 0.77), while the obstetric conjugate, interspinous, and intertuberous distances were not.ConclusionsTPU can accurately and reliably measure the AMD, a novel pelvic diameter in breech presentation. Importantly, a smaller AMD was associated with an increased risk of intrapartum cesarean section if vaginal breech birth was attempted. Consequently, TPU could represent an alternative to MR pelvimetry and support women in deciding their preferred mode of birth in breech presentation.

BackgroundThe effects of mode of birth for women in preterm breech labour could not be successfully determined in randomised trials. We aimed to explore the effect of caesarean birth on perinatal mortality for women in spontaneous-onset preterm labour with a singleton baby presenting breech through target trial emulation.MethodsA target trial emulation of a parallel group randomised controlled trial using routinely collected Scottish electronic health record data was performed. Participants were pregnant women at 24–36 gestational weeks with a singleton breech baby, no prior caesarean birth, in spontaneous labour with a live baby at labour onset (1 January 1997 to 31 December 2019). We compared caesarean birth (intervention) to vaginal breech birth (control) in a per-protocol analysis (actual mode of birth). The primary outcome was extended perinatal mortality (intrapartum stillbirths and neonatal deaths). A multiple logistic regression model with inverse probability weight was used to adjust for measured confounders.There were 2,092 caesarean births and 967 vaginal breech births. In the emulated trial, caesarean birth reduced extended perinatal mortality compared to vaginal breech birth (odds ratio [OR] 0.35, 95% confidence interval [CI] 0.27 to 0.43). At 24 weeks’ gestation, caesarean birth decreased the odds of perinatal death by 47.7% (OR: 0.53, 95% CI: 0.35 to 0.78). At 36 gestational weeks it was associated with an 82.1% reduction in the odds of perinatal death (OR: 0.18, 95% CI: 0.10 to 0.32). As the risk of perinatal mortality is inversely correlated with gestational age at birth, seven and 88 caesarean births were needed to prevent one perinatal death at 24 weeks and 36 weeks’ gestation, respectively.ConclusionsCaesarean birth was associated with a reduced risk of extended perinatal mortality in spontaneous preterm singleton breech labour in a per-protocol trial emulation. Observational data that accurately captures planned mode of birth and unmeasured confounders such as breech subtype is required to emulate an intention-to-treat analysis.

ABSTRACTBackgroundAlthough there is ongoing debate, the current consensus is that vaginal breech birth carries a marginal increase in perinatal morbidity and mortality. Due to these risks there have been decreasing numbers of vaginal breech births and subsequently clinical exposure to hands‐on training has declined. However, to confidently care for women who plan a vaginal breech birth or those presenting in advanced labour with an unexpected breech presentation, education in vaginal breech birth remains necessary.AimsThis pilot study aimed to assess the ability of a multimodal teaching program consisting of high‐fidelity physical models, educational videos and a 360° virtual reality video to increase the confidence of maternity staff in their theory and management skills regarding vaginal breech birth. A secondary aim was to determine whether the virtual reality video enhanced learning alongside established techniques.Materials and MethodologyA multimodal teaching program was administered to 20 maternity health staff. They were given a self‐reported pre‐ and post‐intervention scales to assess changes in their confidence. They also provided feedback on the virtual reality video.Results and ConclusionThe teaching program significantly increased maternity staff's confidence in their knowledge and management skills whilst decreasing their anxiety surrounding vaginal breech birth. However, participants did not perceive the 360o virtual reality being of added value. Further studies should examine whether this program leads to objective change in vaginal breech birth knowledge and management skills and ultimately improved clinical outcomes. Additional studies should explore which types of virtual reality technology benefit breech birth education.

Management of breech presentation is a subject of ongoing clinical debate. The cost-effectiveness of improving safe vaginal breech birth is unknown. This study examines potential cost-effectiveness of OptiBreech collaborative care and assesses value of undertaking further research. A decision tree was used to evaluate the potential cost-effectiveness of OptiBreech care versus standard care for a hypothetical cohort of women with confirmed singleton breech pregnancy after 36+ 0 weeks gestation and babies born thereafter for 1 year. Probabilities, costs, and outcomes were obtained from literature and OptiBreech pilot trial. Uncertainty and value of information were analyzed to prioritize future research. The main outcomes were incremental cost-utility and cost-effectiveness ratios, net benefits, cost-effectiveness acceptability curve, and expected value of perfect and perfect partial information. Using preexisting evidence, OptiBreech care is less effective but sufficiently less costly, ie, cost-effective compared with standard care. Influential parameters include cephalic birth rate after external cephalic version, training costs, and vaginal birth rate after opting for vaginal birth. Emerging evidence for OptiBreech care significantly improved the cost-effectiveness ratio. The expected population value of perfect information was £31.5 million, with utilities identified as key research priority. Planned vaginal birth for singleton breech pregnancy may be cost-effective despite a potential loss in health outcomes. Emerging data on the effectiveness of OptiBreech care significantly increased the cost-effectiveness likelihood. Conclusions did not change for litigation cost assumptions or for sole neonatal perspective. Further research on health utilities would provide a valuable reduction in decision uncertainty.

IntroductionOptimal delivery mode for vaginal breech birth at term remains controversial, withvarying recommendations across international guidelines. This study aimed toevaluate common perceptions and outcomes associated with VBB using retrospectivedata, including benefits of cesarean section, maternal and neonatal risks.Material and MethodsWe conducted a monocentric, retrospective cohort study over 21 years at a Germantertiary perinatal center, examining term breech deliveries. Outcomes were comparedbetween planned cesarean section and intended vaginal breech birth, with the lattergroup further categorized by successful and unsuccessful vaginal breech birthattempts.ResultsOf all deliveries, 3.6% (3172) were singleton breech presentations beyond 36 weeksgestation. Among these, 2501 cases (78.8%) were planned cesarean sections, while 671cases (21.2%) were intended vaginal breech births. Within the intended vaginalbreech birth group, 524 (78%) achieved vaginal delivery, whereas 147 (22%) requiredsecondary cesarean section. Maternal outcomes showed significant differences inblood loss (p < 0.001) and hospital stay (p < 0.001), favoring the vaginalbreech birth group with lower blood loss and shorter hospital stays. However,neonatal interventions, including bag-mask ventilation and resuscitation, weresignificantly more frequent in the vaginal breech birth group (p < 0.001), alongwith increased short-term neonatal morbidity such as neonatal infections(p < 0.001), transient tachypnea (p = 0.002), and hypoxic-ischemic encephalopathy(p = 0.008).ConclusionThe findings highlight an increase in intended vaginal breech births with a highrate of successful vaginal deliveries. Vaginal breech birth was associated withfewer maternal complications but elevated short-term neonatal morbidity. The resultsunderscore the importance of individualized counseling and skilled provider presencewhen considering vaginal breech birth, supporting informed maternal choice andoptimized delivery outcomes.

Vaginal breech birth management: serious mobile game design and evaluation for midwifery students.

The safety of vaginal breech birth is associated with the skill and experience of professionals in attendance, but minimal training opportunities exist. OptiBreech collaborative care is an evidence-based care bundle, based on previous research. This care pathway is designed to improve access to care and the safety of vaginal breech births, when they occur, through dedicated breech clinics and intrapartum support. This improved process also enhances professional training. Care coordination is accomplished in most cases by a key breech specialist midwife on the team. The goal of this qualitative inventory was to describe the roles and tasks undertaken by specialist midwives in the OptiBreech care implementation feasibility study. Semistructured interviews were conducted with OptiBreech team members (17 midwives and 4 obstetricians; N = 21), via video conferencing software. Template analysis was used to code, analyze, and interpret data relating to the roles of the midwives delivering breech services. Tasks identified through initial coding were organized into 5 key themes in a template, following reflective discussion at weekly staff meetings and stakeholder events. This template was then applied to all interviews to structure the analysis. Breech specialist midwives functioned as change agents. In each setting, they fulfilled similar roles to support their teams, whether this role was formally recognized or not. We report an inventory of tasks performed by breech specialist midwives, organized into 5 themes: care coordination and planning, service development, clinical care delivery, education and training, and research. Breech specialist midwives perform a consistent set of roles and responsibilities to co-ordinate care throughout the OptiBreech pathway. The inventory has been formally incorporated into the OptiBreech collaborative care logic model. This detailed description can be used by employers and professional organizations who wish to formalize similar roles to meet consistent standards and improve care.

When asked why nearly all doctors refer their breech cases to surgery, despite non-surgical breech birth being permitted throughout the United States, an obstetrician will likely cite the Term Breech Trial (TBT). This study, conducted in 2000, decisively concluded that planned cesarean delivery is safer than vaginal breech delivery. However, a review of the literature suggests that the decline of vaginal breech deliveries was a long time in the making. From the 1950s, once the perceived risks of breech births were accepted as a fact, numerous studies advocated more liberal use of cesarean delivery for breech babies and suggested strategies to limit vaginal breech births. By the late 1970s, as the majority of breech patients underwent surgery, a vicious cycle of collective forgetting began. Hospitals and medical training programs abandoned the non-surgical option, leaving younger generations of unskilled doctors reluctant to perform the complex procedure. As health organizations criticized the overuse of cesarean sections in the ensuing decades, obstetricians faced a growing dilemma in breech management, continuing to perform surgeries even while questioning their benefits. The 2000 study sanctioned this existing state of practice, which had been evolving over decades and in which collective forgetting played a crucial part.

PurposeThis study examines whether the perinatal mortality rates (up to 7 days postpartum) of successful vaginal breech birth (VBB) align with those of vaginal cephalic birth (VCB) under the current practice of risk stratification and promotion of VBB in Germany. This study excludes births that did not result in vaginal breech birth, i.e., cases where a vaginal birth was attempted but discontinued.MethodsA retrospective cohort analysis of the 2021 German population dataset compared 1435 VBBs to 422,019 VCBs. Maternal and neonatal short-term outcomes were analyzed using Chi-squared and Mann–Whitney U tests.ResultsMain outcome: No significant difference in perinatal mortality rates between VBB and VCB. Other neonatal outcomes: Mean arterial blood gas levels and mean APGAR levels were lower in the breech group. The need for resuscitation measures and transfers to the pediatric hospital were increased. Maternal outcomes: Births in the breech group received labor augmentation more frequently and had higher rates of episiotomies. They had lower rates of perineal tears and postpartum complications. The rates of hysterectomies and increased postpartum hemorrhage did not differ significantly.ConclusionWith thorough risk stratification and interdisciplinary expert management, perinatal mortality rates (up to 7 days postpartum) of VBBs align with VCBs. However, higher neonatal intervention rates in VBB highlight the need to ensure adequate resources and preparedness for postnatal support.

Research on community (home or birth center) twin birth is scarce. This study evaluates outcomes of twin pregnancies entering care with a single community practitioner. This is a retrospective observational cohort study of 100 consecutive twin pregnancies planning community births during a 12-year period. Outcomes measured included mode of birth; birth weights; Apgar scores; ante-, intra-, and post-partum transports; perineal integrity; birth interval; blood loss; chorionicity; weight concordance; and other maternal or neonatal morbidity. 31 women (31%) transferred to a hospital-based clinician prior to labor. Of the 69 pregnancies still under the obstetrician's care when labor began, 79.7% (n = 55) were Dichorionic Diamniotic and 21.3% (n = 14) were Monochorionic Diamniotic. The vaginal birth rate was 91.3% (n = 63): 77.3% for primips and functional primips (no previous vaginal births) and 97.9% for multips. Six mothers (8.7%) had in-labor cesareans (1 multip and 5 primips). Rates of vaginal birth did not vary significantly by chorionicity. There were 8 transports in labor (11.6%): 2 vaginal and 6 cesareans. Average gestational age was 39.0 weeks (range 35-42). Compared to primiparas, multiparas had less perineal trauma and higher rates of vaginal birth and spontaneous vaginal birth. One twin infant and one mother required postpartum hospital transport. Of the babies born in a community setting, there was no serious morbidity requiring hospital treatment. A community birth can lead to high rates of vaginal birth and good outcomes for both mothers and babies in properly selected twin pregnancies. Community twin birth with midwifery style care under specific protocol guidelines and with a skilled practitioner may be a reasonable choice for women wishing to avoid a cesarean section-especially when there is no option of a hospital vaginal birth. Training all practitioners in vaginal twin and breech birth skills remains an imperative.

Cesarean delivery is the most common mode of delivery among extremely preterm infants but there are insufficient data regarding the best mode of delivery among extremely preterm singletons. The objective of this study was to compare the rate of death or severe neurodevelopmental impairment among extremely preterm singletons by actual mode of delivery. Observational study using prospectively collected data from 25 US medical centers. We included postnatally-treated singletons with birth weight 401-1000 g, gestational age 22 + 0/7-26 + 6/7 weeks, without a major birth defect, born 2006-2016. Death or severe neurodevelopmental impairment (Bayley Scales of Infant Development-3rd edition cognitive composite score<70, cerebral palsy (Gross Motor Function Classification Scale >3), bilateral blindness, or bilateral hearing loss) at 18-26 month follow-up were compared by mode of delivery (cesarean, vaginal including vertex or breech) using propensity score analysis to adjust for baseline characteristics. There was no difference in death or severe neurodevelopmental impairment between cesarean and vaginal (vertex or breech) births (42.4% cesarean vs. 47.2% vaginal; adjusted odds ratio (aOR), 95% confidence intervals (CI); 1.03, 0.91-1.17). Both cesarean delivery (26.8% cesarean vs. 51.5% breech vaginal; aOR: 0.71; 95% CI: 0.55-0.92) and vertex vaginal delivery (28.5% vertex vaginal vs. 51.5% breech vaginal; aOR: 0.59; 95% CI: 0.45-0.76) were associated with lower mortality compared with breech vaginal delivery. Among postnatally-treated extremely preterm singletons, there was no difference in death or severe neurodevelopmental impairment between cesarean or vaginal delivery. Both vertex vaginal and cesarean delivery were associated with lower mortality compared with breech vaginal delivery.

IntroductionOptimal counseling of women for vaginal breech birth requires consideration of both established and emerging risk factors for adverse perinatal outcomes. Currently, rising prevalences of maternal obesity and impaired glucose tolerance challenge obstetric care. We aimed to investigate the effects of these parameters on the outcome of vaginal breech birth to improve counseling practices.Material and MethodsA total of 361 women (without previous vaginal births) attending vaginal birth of a singleton fetus in breech presesntation between 01/2015 and 11/2021 were included in this retrospective single‐center study. Data were derived from the hospital data base. We analyzed the effect of the maternal body mass index (BMI) at birth (compared to pre‐pregnancy BMI), excessive weight gain, gestational diabetes, and neonatal birthweight on obstetrical and neonatal short‐term outcomes (intrapartum cesarean delivery, performance of obstetric maneuvers (Løvset‐, Bracht‐, Veit‐Smellie maneuver and Bickenbach's arm delivery), admission to the neonatal unit, Apgar score after 5 minutes <7, and arterial cord pH‐value <7.10). Multivariable logistic regression was used for analysis and adjustment of variables.ResultsOverall, 246 women (68.1%) had a successful vaginal birth. Intrapartum cesarean delivery (n = 115/361; 31.9%) was independently associated with maternal BMI at birth (p = 0.0283, aOR = 1.87 (1.19–3.97)) if birthweight was ≥3800 g. The rate of intrapartum cesarean delivery was also higher in women with gestational diabetes (p = 0.0030, aOR = 10.83 (2.41‐60.84)). A significantly higher risk of neonatal acidosis (arterial pH‐value <7.10) was observed in women with BMI at birth ≥30 kg/m2 (p = 0.0345, aOR = 1.84 (1.04–3.22)) without affecting other outcomes. Pre‐pregnancy BMI, gestational weight gain and BMI‐gain did not significantly affect the obstetrical and neonatal birth outcomes.ConclusionsWhen neonatal birthweight is ≥3800 g, maternal BMI at birth (p = 0.0283; aOR = 1.87 (1.19–3.97)) is independently associated with the rate of intrapartum cesarean delivery. However, pre‐pregnancy BMI and BMI‐gain during pregnancy were not associated with the need for intrapartum cesarean delivery or other adverse outcomes. Consequently, BMI at the time of birth could be more informative than pre‐pregnancy BMI and may improve counseling of women attempting vaginal breech birth.

Objective(s)A critical area of obstetrics that demands proficient training is the management of breech deliveries. There was a notable decline in the number of vaginal breech deliveries in the following years, establishing CS as the preferred method of delivery for such cases. Cohort studies using targeted screening and skilled practitioners demonstrated little differences between the two delivery. Skills acquisition at the patient’s bedside is very difficult to obtain, particularly in the youngest trainees. Simulation teaching has largely become a part of the training curricula for many obstetrics and gynecology residency programs. Study designThis was a prospective, randomized, controlled, single-center study. Residents were randomly assigned in two groups with similar characteristics. Group A attended a formal lecture. Group B received the study material and recording of the lecture as digital home learning. Lecture and simulation focused on vaginal breech delivery. After one month both groups underwent a simulation test addressed to assist a vaginal breech birth. Four supervisors evaluated all videos. Time needed for birth, and evaluation scales as Objective Structured Clinical Examination were recorded. A questionnaire was completed online using Google Forms with 6 questions. The primary outcome was to compare the evaluation for each item and globally within groups. A secondary outcome was the evaluation of questionnaire results within the two groups. ResultsThirty-two participants were recruited and randomized. None of the participants withdrew from the study. For the primary outcome, all examined variables (Time, Rumping, Legs, Body, Arms, Head, Total Point) did not present differences in supervisors’ evaluations. For the secondary outcome, Group B showed higher values in two questions. Conclusion(s)The major finding of our study is that digital learning and formal lecture presented similar results on resident knowledge. Teaching programs involving mannequin simulation − both high and low fidelity − are reproducible and efficient for skill retain in obstetric emergencies, particularly in low incidence emergencies. The main limitation of our study was the small sample size. In addition, it is possible that a scenario without deviation or a lecture more focused on possible deviation from normal could modify residents’ results facing breech delivery.

The majority of breech fetuses are delivered by cesarean birth as few physicians are trained in vaginal breech birth. An external cephalic version (ECV) can prevent cesarean delivery and the associated morbidity in these patients. Current guidelines recommend that all patients with breech presentation be offered an ECV attempt. Not all attempts are successful, and an attempt does carry some risks, so shared decision-making is necessary. To aid in patient counseling, over a dozen prediction models to predict ECV success have been proposed in the last few years. However, very few models have been externally validated, and thus, none have been adopted into clinical practice. This study aims to use data from a U.S. hospital to provide further data on ECV prediction models.This study retrospectively gathered data from Carle Foundation Hospital and used it to test six models previously proposed to predict ECV success. These models were Dahl 2021, Bilgory 2023, López Pérez 2020, Kok 2011, Burgos 2010, and Tasnim 2012 (GNK-PIMS score).A total of 125 patients undergoing 132 ECV attempts were included. A total of 69 attempts were successful (52.2%). Dahl 2021 had the greatest predictive value (area under the curve [AUC]: 0.779), whereas Tasnim 2012 performed the worst (AUC: 0.626). The remaining models had similar predictive values as each other (AUC: 0.68-0.71). Bootstrapping confirmed that all models except Tasnim 2012 had confidence intervals not including 0.5. The bootstrapped 95% AUC confidence interval for Dahl 2021 was 0.71 to 0.84. In terms of calibration, Dahl 2021 was well calibrated with predicted probabilities matching observed probabilities. Bilgory 2023 and López Pérez were poorly calibrated.Multiple prediction tools have now been externally validated for ECV success. Dahl 2021 is the most promising prediction tool. · Prediction models can be powerful tools for patient counseling.. · The odds of ECV success can estimated based on patient factors and clinical findings.. · Of the six tested models, only Dahl 2021 appears to have good predictive value and calibration..

To develop prediction models for intrapartum caesarean section in vaginal breech birth. This single-center cohort-study included 262 nulliparous and 230 multiparous women attempting vaginalbreech birth. For both groups, we developed and (internally) validated three models for the prediction of intrapartum cesarean section. The prediction model for nulliparous women (AUC:0.67) included epidural analgesia (aOR 2.14; p=0.01), maternal height (aOR 0.64 per 10 cm; p=0.08), birthweight≥3.8 kg (aOR 2.45; p=0.03) and an interaction term describing the effect of OC if birthweight is≥3.8 kg (aOR0.24; p=0.04). An alternative model for nulliparous women which, instead of birthweight, included fetal abdominal circumference with a cut-off at 34 cm (aOR 1.93; p=0.04), showed similar performance (AUC: 0.68). The prediction model for multiparous women (AUC: 0.77) included prelabor rupture of membranes (aOR 0.31; p=0.03), epidural analgesia (aOR 2.42; p=0.07), maternal BMI (aOR 2.92 per 10 kg/m2; p=0.01) and maternal age (aOR 3.17 per decade; p=0.06). Our prediction models show the most relevant risk factors associated with intrapartum cesarean section in vaginal breech birth for both nulliparous and multiparous women. Importantly, this study clarifies the role of the OC byshowing that this parameter is only associated with intrapartum cesarean section if birthweight is above 3.8 kg (or abdominal circumference is above 34 cm). Conversely, knowing the OC when the birthweight is less than 3.8 kg (orabdominal circumference is less than 34 cm) did not improve prediction of this surgical outcome.

IntroductionThe appropriate mode of delivery for breech babies is a topic of ongoing debate. After the publication of the Term Breech Trial in 2000, the proportion of breech babies delivered vaginally in Sweden rapidly dropped to 7% from 26%. In 2015, international guidelines changed to once again recommend offering vaginal breech deliveries in select cases. In 2017, a Swedish hospital established a dedicated Breech Team to provide safe vaginal breech deliveries according to the new guidelines. The aim of this study is to compare neonatal morbidity in the group planned for cesarean breech delivery with the group planned for vaginal breech delivery treated in accordance with the new guidelines. The study adds to the literature by providing insights into the consequences of reintroducing vaginal breech births in a high‐resource health‐care setting.Material and MethodsA prospective observational study was conducted at Södersjukhuset's maternity ward with 1067 women who gave birth to a single breech fetus at term. Outcomes were compared between the planned vaginal and planned cesarean delivery groups using intention‐to‐treat analysis and multivariate analysis to control for confounders.ResultsOut of the 1067 women, 78.9% were planned for cesarean delivery and 21.1% were planned for vaginal delivery. The planned vaginal group had a significantly greater risk for neonatal morbidity compared to the planned cesarean group (3.1% vs. 0.7%; OR 4.44, 95% CI 1.48–13.34). The risk difference remained significant after controlling for confounders.ConclusionsPlanned vaginal breech delivery was associated with an increased risk of neonatal mortality and short‐term morbidity compared to planned cesarean breech delivery in accordance with the new guidelines. The potential risks and benefits of planned vaginal breech delivery should be carefully weighed against those of planned cesarean delivery.

Investigate maternal and neonatal outcomes associated with breech presentation in planned community births in the United States, including outcomes associated with types of breech presentation (i.e., frank, complete, footling/kneeling). Secondary analysis of prospective cohort data from a national perinatal data registry (MANA Stats). Planned community birth (homes and birth centers), United States. Individuals with a term, singleton gestation (N = 71,943) planning community birth at labor onset. Descriptive statistics to calculate associations between types of breech presentation and maternal and neonatal outcomes. Maternal: intrapartum/postpartum transfer, hospitalization, cesarean, hemorrhage, severe perineal laceration, duration of labor stages and membrane rupture Neonatal: transfer, hospitalization, NICU admission, congenital anomalies, umbilical cord prolapse, birth injury, intrapartum/neonatal death. One percent (n = 695) of individuals experienced breech birth (n = 401, 57.6% vaginally). Most fetuses presented frank breech (57%), with 19% complete, 18% footling/kneeling, and 5% unknown type of breech presentation. Among all breech labors, there were high rates of intrapartum transfer and cesarean birth compared to cephalic presentation (OR 9.0, 95% CI 7.7-10.4 and OR 18.6, 95% CI 15.9-21.7, respectively), with no substantive difference based on parity, planned site of birth, or level of care integration into the health system. For all types of breech presentations, there was increased risk for nearly all assessed neonatal outcomes including hospital transfer, NICU admission, birth injury, and umbilical cord prolapse. Breech presentation was also associated with increased risk of intrapartum/neonatal death (OR 8.5, 95% CI 4.4-16.3), even after congenital anomalies were excluded. All types of breech presentations in community birth settings are associated with increased risk of adverse neonatal outcomes. These research findings contribute to informed decision-making and reinforce the need for breech training and research and an increase in accessible, high-quality care for planned vaginal breech birth in US hospitals.

Barriers and facilitators for implementation of OptiBreech collaborative care: A qualitative study as part of an implementation process evaluation