Vaginal Delivery For Breech Presentation Research Articles

Confronting the Fear: Our Experience with Breech Vaginal Delivery-A Retrospective Analysis

Introduction: Mode of delivery for term singleton breech presentation has been a raging topic of discussion for decades and continues to be so. The ‘Term Breech Trial’ was a big blow to vaginal breech delivery leading to a torrential increase in the rate of caesarean sections the world over. We intend to compare and evaluate the maternal and perinatal outcomes of vaginal versus caesarean section breech delivery so as to analyse the safety of vaginal delivery for breech presentation. Objectives: Analyse and compare perinatal and maternal outcomes between vaginal versus caesarean deliveries of term or near-term singleton breech presentation. Materials and Methods: Retrospective comparison between 30 vaginal breech deliveries (Group 1) and 252 caesarean deliveries (Group 2) done for singleton breech presentation between 36 weeks to 42 weeks, either in early or advanced labour conducted between January 2015-January 2022 at various Military Hospitals. Statistical Analysis: The association between maternal and perinatal outcomes was estimated using the Chi-square test and Fisher exact test with P < 0.05 considered statistically significant. Results: No maternal complications were noted in Group 1 while in Group 2 surgical site infection and post-partum haemorrhage of varying degree, was noted in 14% cases and 7% cases respectively which was statistically significant. There was no significant difference noted between the groups with regard to neonatal outcomes or NICU admission. Conclusion: Vaginal delivery for termsingleton breech is a reasonable option in well-selected patients at optimally equipped centres, in the hands of an experienced Obstetrician.

Determinants Of The Neonatal Prognosis In Briech Delivery In Primipparous About 627 Cases At The Nabil Choucair Health Center In Dakar, Senegal From 2005 To 2023

OBJECTIVES: The objectives were to describe the frequency and sociodemographic profile of primiparous women with fetuses in breech presentation, and to assess the maternofetal prognosis of breech presentation in primiparous women. MATERIALS AND METHODS: This was a retrospective, descriptive and analytical study carried out at the Nabil Choucair Health Center over a period from January 1, 2005 to December 31, 2023. The study included all primiparous women carrying a singleton pregnancy. whose term was greater than 22 weeks of amenorrhea who came to give birth at the Nabil Choucair health center. Patients whose files were unusable due to a significant number of missing data, as well as terminated pregnancies were excluded. Data entry and analysis were carried out using Excel software. It included two parts: descriptive analysis and analytical analysis. In the descriptive analysis, the quantitative variables were described in number, percentage and average. The analytical study consisted of researching the link between the route of delivery and the parameters which can influence it theoretically and thus as well as the maternofetal prognosis. The Chi2 test was used for comparison of proportion. The difference was statistically significant when the p value was strictly less than 0.05. The Odds surrounded by the 95% confidence interval made it possible to determine the strength of the link. CONCLUSION: Vaginal delivery of breech presentation in primiparous women is still possible in a level II maternity ward with an operating theater. Indications for cesarean section should be reserved for breech presentations in primiparous women associated with other risk factors.

Cesarean versus vaginal delivery for breech presentation is an independent risk factor for long-term pediatric respiratory hospitalization of the offspring.

To compare the long-term respiratory morbidity of offspring born by cesarean delivery for breech presentation with that of those delivered vaginally. A population-based cohort analysis including all singleton breech deliveries between the years 1991 and 2014, comparing long-term respiratory morbidity of offspring born in breech presentation, according to mode of delivery. Offspring with congenital malformations, perinatal deaths, and instrumental deliveries were excluded. Respiratory morbidity included hospitalizations (up to age 18 years), as recorded in hospital records. A Kaplan-Meier survival curve compared cumulative respiratory morbidity. A Weibull parametric survival model controlled for confounders and repeat deliveries. A total of 7337 breech deliveries were included; 6376 (86.9%) cesarean deliveries and 961 (13.1%) vaginal breech deliveries. The Kaplan-Meier survival curve demonstrated higher cumulative incidence of respiratory morbidity in the cesarean delivery group compared with vaginal delivery (log rank test P= 0.006). Using a Weibull parametric survival model to control for confounders, cesarean delivery was found to be an independent risk factor for long-term respiratory morbidity of the offspring (adjusted hazard ratio 1.87, 95% confidence interval 1.32-2.65, P< 0.001). Cesarean versus vaginal delivery for breech presentation is an independent risk factor for long-term pediatric respiratory morbidity of the offspring.

Mode of vaginal delivery in breech presentation and perinatal outcome.

To compare a perinatal outcome in breech presentation depending on different modes of vaginal breech delivery (VBD). Over the course of 13 years (2005-2018), perinatal outcome of newborns was compared among 98 singleton pregnancies (64 term pregnancies and 34 preterm pregnancies) completed with VBD divided into six groups depending on the mode of delivery used (Bracht, Müller, Thiessen, classical arm release, Mauriceau-Levret-Veit-Smellie (MLVS), and Vermelin´s spontaneous vaginal delivery). Also, maternal demographic parameters were observed. Of 98 singleton pregnancies, the most frequently used mode was Thiessen (35.71%), followed by MLVS technique (25.51%), Bracht (22.45%), Vermelin (13.27%), classical arm release (2.04%) and Müller (1.02%). Newborns with Apgar score ≤ 7 at 5 min. were transferred to the neonatal intensive care unit (NICU), which included 15.31% of newborns (total 15 newborns: 1 term and 14 preterm newborns). The incidence of episiotomy was 63.27%. Seventy-point five percent of women included in the study were ≤ 35 years of age, and 37.76% were multiparas. Delivery was induced in 7.14% cases. Less- traumatizing actions during VBD have less harmful consequences and better perinatal outcome. Lower Apgar score was noted with the aggressiveness of the mode of VBD.

Decline of Obstetrical Medical Technique and Its Social Acceptance : Is the Loss of Vaginal Delivery for Breech Presentation resulted from Oppression for the Pregnant Women

Decline of Obstetrical Medical Technique and Its Social Acceptance : Is the Loss of Vaginal Delivery for Breech Presentation resulted from Oppression for the Pregnant Women

Is induction of labor a reasonable option for breech presentation?

Whereas spontaneous onset of labor and vaginal delivery for breech presentation is considered to be a safe and effective option in selected cases, the safety of induction of labor is not established yet. The objectives of this study were to describe the outcomes of pregnancy in women induced with a fetus in breech presentation and compare the outcomes with those undergoing planned cesarean delivery. We performed a secondary analysis of the observational prospective multicenter PREMODA study, including all singleton breech deliveries after 37weeks in 174 centers in France and Belgium. We excluded women with spontaneous onset of labor, scarred uterus or intrauterine fetal death. Our study population consisted of women with either induction of labor or 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. Our study population consisted of 4138 women, 218 with induction of labor and 3920 with planned cesarean. Two-thirds (67.4%) of the women in the induction of labor group delivered vaginally. There was no significant difference between the groups for the primary outcome (48 [1.2%] in the planned cesarean group vs 3 [1.4%] in the induction of labor group, P=0.75). Moreover, none of the criteria of the composite primary outcome was significantly more frequent in the induction of labor group. Induction of labor for breech presentation does not seem to increase neonatal mortality or severe neonatal morbidity compared with planned cesarean delivery.

Holding the ground for midwifery, for women

Planned vaginal delivery in breech presentation is accompanied by an excess neonatal risk that has, however, rarely been compared to that of delivery in vertex presentation. Because of the severity of complications that can occur in long-term follow-up, the risk of asphyxia is of particular concern.To assess immediate neonatal status after a planned vaginal delivery of fetuses in breech compared with vertex presentation, we planned a retrospective hospital cohort study of singleton term deliveries from 2000 to 2011. The indicators used to assess neonatal status were: 5-min Apgar score < 7, acidosis, both moderate (pH < 7.15) and severe (pH < 7.0), asphyxia (pH < 7.0 and base deficit ≥ 12.0 mmol/L), transfer to the neonatal intensive care unit (NICU), and in-hospital neonatal death.Compared with 43,595 trials of vaginal delivery in vertex presentation at term during the 12-year study period (93.8% of all vertex presentations), the 665 breech deliveries for which planned vaginal delivery was planned (43.2% of all breech presentations) had a quadrupled risk of severe acidosis (ORa 4.3 [2.2–7.5]), but no increase in the risk of asphyxia (ORa 0.7 [0.1–3.0]), NICU transfer (ORa 0.8 [0.4–1.3]) or in-hospital death (ORa 1.3 [0.1–6.0]). Moreover, compared with the 876 planned cesareans, the risk of severe acidosis in the 665 trials of vaginal delivery in breech presentation was four times higher (OR 4.3 [2.3–4.7]), but we observed no increase in neither asphyxia nor other risks studied.In our hospital, planned vaginal delivery is safe for breech presentations because it is associated with an increase of severe acidosis but not asphyxia.

Is trial of labor harmful in breech delivery? A cohort comparison for breech and vertex presentations

IntroductionPlanned vaginal delivery in breech presentation is accompanied by an excess neonatal risk that has, however, rarely been compared to that of delivery in vertex presentation. Because of the severity of complications that can occur in long-term follow-up, the risk of asphyxia is of particular concern. Material and methodsTo assess immediate neonatal status after a planned vaginal delivery of fetuses in breech compared with vertex presentation, we planned a retrospective hospital cohort study of singleton term deliveries from 2000 to 2011. The indicators used to assess neonatal status were: 5-min Apgar score<7, acidosis, both moderate (pH<7.15) and severe (pH<7.0), asphyxia (pH<7.0 and base deficit≥12.0mmol/L), transfer to the neonatal intensive care unit (NICU), and in-hospital neonatal death. ResultsCompared with 43,595 trials of vaginal delivery in vertex presentation at term during the 12-year study period (93.8% of all vertex presentations), the 665 breech deliveries for which planned vaginal delivery was planned (43.2% of all breech presentations) had a quadrupled risk of severe acidosis (ORa 4.3 [2.2–7.5]), but no increase in the risk of asphyxia (ORa 0.7 [0.1–3.0]), NICU transfer (ORa 0.8 [0.4–1.3]) or in-hospital death (ORa 1.3 [0.1–6.0]). Moreover, compared with the 876 planned cesareans, the risk of severe acidosis in the 665 trials of vaginal delivery in breech presentation was four times higher (OR 4.3 [2.3–4.7]), but we observed no increase in neither asphyxia nor other risks studied. ConclusionIn our hospital, planned vaginal delivery is safe for breech presentations because it is associated with an increase of severe acidosis but not asphyxia.

Comparison of Apgar scores in breech presentations between vaginal and cesarean delivery.

Objective:The mode of delivery in breech presentation (BP) is controversial. Several studies have reported the advantages and disadvantages of delivery mode in BP. The aim of this study was to compare the Apgar scores in BPs between vaginal and cesarean delivery.Materials and Methods:A retrospective study was conducted at Dr. Zainoel Abidin General Hospital from January 2010 to December 2012. Data on the mode of delivery and Apgar scores at 1 and 5 min for infants with a BP were extracted from the medical records. Logistic regression was employed to assess the correlation between mode of delivery and Apgar scores. In addition, a meta-analysis was conducted to summarize findings from other regions.Results:A total of 205 (3.9%) BPs among 5252 deliveries between January 2010 and December 2012 were analyzed for this study. There were 26% (52 cases) vaginal and 74% (153 cases) cesarean deliveries. The mode of delivery for BP had a significant association with Apgar score at 1 min (odds ratio [OR] 95% confidence interval [CI] = 6.462 [2.476–16.870], P = 0.0001) and 5 min (OR 95% CI = 7.727 [1.416–42.175], P = 0.018). Our meta-analysis showed that the delivery mode had a significant association with Apgar score in BP (OR: 3.69; 95% CI: 2.18–6.26, P = 0.0001).Conclusions:There was a significant association between Apgar scores in BPs and mode of delivery. Our results suggest better outcomes for cesarean than vaginal delivery in BPs.

Impact de la version par manœuvre externe sur le pronostic obstétrical dans une équipe à fort taux de réussite de l’accouchement vaginal du siège

To analyse the impact of external cephalic version (ECV) on caesarean section rate in a team with a high success rate of vaginal delivery in breech presentation. Retrospective monocentric study including 298patients with a breech presentations between 33 and 35weeks of amenorrhea followed at our university hospital and delivered after 35weeks, between 1stJanuary2011 and 31stDecember2013. Patients were divided into 2groups: planned ECV (n=216patients) versus no planned ECV (n=57patients). Our rate of successful vaginal breech delivery over the period of the study was 61.1%. We performed 165ECV, with a 21.8% success rate. The average term of the attempt of ECV was 36.7weeks of amenorrhea. The caesarean section rate was not significantly different in the planned ECV group, even after adjustment on age, parity and previous caesarean delivery (adjusted OR=1.67 [0.77-3.61]). Attempt of ECV did not reduce the number of breech presentation at delivery (61.1% versus 61.4% [P=0.55]). Planned ECV in our center with a high level of breech vaginal delivery did not significantly impact our cesarean section rate.

Expedited versus conservative approaches for vaginal delivery in breech presentation.

In a vaginal breech birth there may be benefit from rapid delivery of the baby to prevent progressive acidosis. However, this needs to be weighed against the potential trauma of a quick delivery. The objective of this review was to assess the effects of expedited vaginal delivery (breech delivery from umbilicus to delivery of the head within one contraction) on perinatal outcomes. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 May 2015) and reference lists of retrieved studies. Randomised trials of expedited vaginal breech delivery compared with delivery not routinely expedited in women undergoing vaginal breech delivery. Two review authors independently assessed the one identified trial for inclusion.If studies are included in future updates, two review authors will assess risk of bias, extract data and check data for accuracy. No studies were included. There is not enough evidence to evaluate the effects of expedited vaginal breech delivery.

Medico-legal litigation in Obstetrics: a characterization analysis of a decade in Portugal.

It was to analyse the most critical areas in Obstetrics and to suggest measures to reduce or avoid the situations most often involved in these disputes. Obstetrics cases submitted to the Medico-legal Council since the creation of the National Institute of Legal Medicine and Forensic Sciences in 2001 until 2011 were evaluated. A comprehensive characterization, determination of absolute/relative frequencies, hypothesis of a linear trend over the years and the association between each parameter was done. The analysis has shown no significantly linear trend. The most common reasons for disputes were perinatal asphyxia (50%), traumatic injuries of the newborn (24%), maternal sequelae (19%) and issues related to prenatal diagnosis and/or obstetric ultrasound (5.4%). Perinatal asphyxia showed no significantly linear trend (p=0.58) and was usually related to perinatal deaths or permanent neurologic sequelae in newborn children. Traumatic injuries of the newborn, mostly related to instrumented deliveries, shoulder dystocia or vaginal delivery in breech presentation, has shown a significantly increased linear trend (p<0.001), especially related to instrumented deliveries. The delay/absence of cesarean section was the clinical procedure questioned in a significantly higher number of cases of perinatal asphyxia (68.7%) and of traumatic lesions of the newborn due to instrumented deliveries (20.5%). It is important to improve and correct theoretical/practical daily clinical performance in these highlighted areas, in order to reduce or even avoid situations that could end up in medico-legal litigations.

Prehospital Breech Delivery with Fetal Head Entrapment –A Case Report and Review

We present a case in which an emergency medical services (EMS) crew was called for a precipitous breech delivery with fetal head entrapment that was unrelieved following standard prehospital interventions and eventually resulted in neonatal cardiac arrest and death. Although this is a rare occurrence, EMS responders must have adequate training and guidelines on how to assist with vaginal delivery of breech presentation and how to appropriately manage fetal head entrapment in the field. There is little literature to provide guidance but it appears that standard EMS teaching does not represent current best obstetrical practice. We review the available literature, make expert recommendations, and provide a sample new treatment guideline for basic life support, advanced life support, and EMS physician response. Key words: prehospital; fetal head entrapment; breech delivery

Kielland's forceps: demise before the 100th anniversary?

To the Editor: As the time for the centennial of the Kielland’s forceps approaches, one ponders: will this elegant instrument have its demise before its 100th anniversary? Introduced in 1915 by Dr Christian Kielland, a Norwegian obstetrician, for the “deep transverse arrest,” it evolved into the instrument of choice for arrest of descent with occipito-transverse or occipito-posterior position of a cephalic presentation.1.Patterson W.R. The Kielland forceps.Can Med Assoc J. 1928; 18: 177-180PubMed Google Scholar The malpresenting baby would often not be large, as opposed to a non-malpresenting baby that would usually be large to have arrested in the first place. With a high likelihood of failure with attempts at manual rotation or a rotational vacuum, the Kielland’s forceps became an ideal instrument for facilitating a vaginal birth for fetal malposition in cephalic presentation. The relatively straight handle with a gentle backward pelvic curve and a sliding lock were ingenious additions to the obstetric forceps design, allowing easy application to a severely asynclitic head. Further, this design, when combined with the Scanzoni manoeuvre, allowed rotation of up to 180 degrees within the tight constraints of the maternal pelvis due to a relatively small circle of rotation. Given the usual normal-sized baby being delivered, once the head could be successfully rotated, most skilled users would agree that the risk of a significant perineal laceration was small. However, the last decade has witnessed a rapid decline in the use of Kielland’s forceps.2.Ramin S.M. Little B.B. Gilstrap 3rd., L.C. Survey of forceps delivery in North America in 1990.Obstet Gynecol. 1993; 81: 307-311PubMed Google Scholar, 3.Vacca A. Current obstetric training programs are unlikely to provide registrars with sufficient skill in the safe use of Kielland forceps.Aust N Z J Obstet Gynaecol. 2000; 40: 226-227Crossref PubMed Google Scholar This can be attributed to concerns regarding poor neonatal outcomes that were associated with the use of Kielland’s forceps.4.Patel R.R. Murphy D.J. Forceps delivery in modern obstetric practice.BMJ. 2004; 328: 1302-1305Crossref PubMed Scopus (95) Google Scholar In the litigious field of obstetrics, it was tempting to give up a controversial practice for the easier option, the Caesarean section. Given the medico-legal climate, although North American centres were slow in adopting the use of Kielland’s forceps, they were quicker to let it go. However, more recent evidence suggests that the concerns regarding neonatal outcomes may have been misplaced. A retrospective review of deliveries at a tertiary care centre over a four-year period compared the use of Kielland’s forceps, rotational ventouse and emergency Caesarean section.5.Tempest N. Hart A. Walkinshaw S. Hapangama D.K. A re-evaluation of the role of rotational forceps: retrospective comparison of maternal and perinatal outcomes following different methods of birth for malposition in the second stage of labour.BJOG. 2013; 120: 1277-1284Crossref PubMed Scopus (72) Google Scholar With a 25% Caesarean section rate and a 13% operative vaginal delivery rate, a cohort of approximately 1300 cases that reached full cervical dilatation with fetal malposition was identified. With an intention-to-treat analysis, 80% had an attempted Kielland’s rotation, 8% had an attempted rotational ventouse, and 11% had an emergency Caesarean section. The likelihood of needing a Caesarean section was eight-fold higher if a ventouse was used as opposed to the Kielland’s forceps. Failure of delivery with Kielland’s occurred in 4% of cases. Other than a trend towards an increased rate of shoulder dystocia, no increase in adverse outcomes was noted.5.Tempest N. Hart A. Walkinshaw S. Hapangama D.K. A re-evaluation of the role of rotational forceps: retrospective comparison of maternal and perinatal outcomes following different methods of birth for malposition in the second stage of labour.BJOG. 2013; 120: 1277-1284Crossref PubMed Scopus (72) Google Scholar However, obstetric practice changed before the evidence relating to the long-term outcomes of babies could become available,6.Kotaska A. Menticoglou S. Gagnon R; SOGC Maternal Fetal Medicine Committee. Vaginal delivery of breech presentation. SOGC Clinical Practice Guideline no. 226, June 2009.J Obstet Gynaecol Can. 2009; 31 (567–78): 557-566Abstract Full Text PDF PubMed Scopus (72) Google Scholar leaving a generation of obstetricians who are untrained in the science and art of a rotational forceps delivery. With increasing Caesarean section rates and associated maternal morbidity and mortality, we need ongoing efforts to find viable alternatives to Caesarean section. This leads to the question: is it time to revive the Kielland’s forceps delivery before it is too late? Or should we helplessly watch this endangered species disappear and become a part of the annals of the history of medicine?

Lessons to be learnt in managing the breech presentation at term: an 11-year single-centre retrospective study.

The 2000 publication of the Term Breech Trial significantly impacted obstetric practice in Australia with a rapid increase in delivery of term breech singletons by caesarean section. More reassuring data from European centres who continued to offer vaginal breech deliveries to carefully selected women have led to a softening of international guidelines which now support an individualised approach to management. The application of this principle to an Australian population, particularly in the wake of such a major change in obstetric practice, has not previously been demonstrated. To compare short-term neonatal and maternal morbidity for infants with a singleton breech presentation born after 37weeks, according to planned mode of delivery. Eleven-year single-centre retrospective study with intention-to-treat analysis based on intended mode of delivery. Two hundred and forty-three of 766 (31.7%) eligible women elected for planned vaginal breech delivery. The overall success rate in this group was 58%. Morbidity rates were low and compare favourably with similar international studies. However, there was a nonsignificant trend towards higher rates of short-term serious neonatal and maternal morbidity in the planned vaginal delivery group (1.6 vs 0.4%, P=0.08 and 8.2 vs 4.8%, P=0.06, respectively). Attempted vaginal delivery for breech presentation remains an option in carefully selected women under strict obstetric protocols.

Childbirth with fetal pelvis presentatio: Challenge in modern obstetrics

The aim was to determine the incidence of fetal breech presentation at term, the factors that determine how the impact of labor and mode of delivery on neonatal outcome in pregnancies with a fetus in breech presentation pelvic presentation is a form of the longitudinal position of the fetus, which leads the pelvis and occurs in approximately 3% of pregnancies. Numerous studies have shown contradictory results regarding the optimal mode of delivery in breech presentation of fetus. A retrospective study at the Hospital of Gynecology and Obstetrics, University Hospital Zemun-Belgrade in the period 01.01.2009-31.12.2011 year. We analyzed data obtained from the delivery protocol, computer databases and annual reports. Study involved 111 pregnant women in the forward singleton pregnancy (37-41 weeks gestation) with fetal pelvis. We analyzed and compared the group of patients who delivered their babies vaginally and the group of patients who delivered their babies by caesarean section (emergency and planned). Analyzed and compared the following parameters: maternal age, parity, gestational age trudnoće, premature rupture of membranes, weight and head circumference fetus at birth, Apgar score and neonatal complications. The data were analyzed by descriptive and analytical statistics. Results are presented tables and graphs. The study period was performed 4665 deliveries, with 111 deliveries in futures fetuses in breech presentation, which is 2.4%. Women delivered vaginally was 79(71%), emergency caesarean section 17(15%), a planned caesarean section 15(14%) pregnant women. The study showed a statistically significant difference in parity (C2=6.23 p<0, 05), with greater participation in the group of primiparas cesarean section, gestational age (t=5.23 p<0,01), weight and head circumference (t=4.37, t=2.47 p<0,01), premature rupture of membranes, (C2=7.72 p<0,01) and gender structure (C2=4.03 p<0,05). The most common indication for elective Caesarean section was prolonged pregnancy, and for an emergency cesarean section because of the delivery routes. There was no statistically significant difference in age of the mother t=1.08, p>0,05, the values of Apgar score in 5 minutes t=1.67 p>0,05, neurological changes p=0.292 and birth trauma, p=0.292 between two groups of neonates. The values of ul minute Apgar score were at the limits of statistical significance p=1.97 p≥0.05. Vaginal delivery in breech presentation, fetal, obstetric an acceptable range, while respecting the principles of good obstetric practice, there is no increase in neonatal morbidity.

Breech presentation at term: Caesarean section or vaginal delivery?

Term breech presentation occurs in 3-4% of all deliveries. Most obstetricians are completely sure how to end delivery when the foetus is in breech presentation, by caesarean section as the only option. The main goal of the paper was to present the method of delivery for term breech presentation analyzed at the Hospital of Gynaecology and Obstetrics and Clinical Centre in Kragujevac, and parameters that influenced the decision on the method of choice to perform delivery with the foetus in breech position. During a three-year prospective study, the course and outcome of all term breech deliveries were under followup. The study involved only deliveries in breech presentation, with a trial of labour ending by vaginal delivery, while elective caesarean section due to breech presentation of the foetus was not included in the study. The following parameters were compared: body mass, newborn's first minute Apgar score and head circumference, gestational maturity, gestational age, delivery duration, maternal level of education and maternal parity. Of total 6,470 deliveries, 653 (10.10%) were finalized by caesarean section. Of these, there were 202 (3.12%) term breech presentations, of which 72 (35.64%) women had caesarean and 130 (64.36%) vaginal delivery. A difference was detected in newborn's body mass and head circumference, delivery duration, maternal level of education and parity between pregnancies terminated surgically in comparison to vaginal delivery, while pregnancy duration, maternal age, first minute Apgar score, and most significantly, perinatal morbidity did not show any difference regardless of the method of delivery for term breech presentation. With respect of all known parameters, vaginal delivery in breech presentation is also accepted.

Fødselsmetode ved seteleie

Vaginal delivery in breech presentation is controversial, but in Norway vaginal delivery is recommended to certain groups of women. We have examined maternal and neonatal outcome at our hospital by mode of delivery to test whether our results support the recommendation. We analyzed data from 385 women who delivered singleton breech fetuses after 34 weeks of gestation in the 10-year period 1997 - 2006 in Nordlandssykehuset, Bodø. Data were analyzed according to intended mode of delivery (caesarean section or vaginal delivery). Outcomes measured were neonatal and maternal mortality and morbidity, indication for caesarean section and use of forceps in vaginal delivery. 36 % of women delivered vaginally, and 39 % by planned and 25 % by acute caesarean section. Forceps were used in 16 % of vaginal deliveries. We found a higher incidence of early neonatal morbidity after vaginal delivery than after caesarean section (11/214 vs. 0/134, p < 0.008), but none of the children had any noticeable morbidity after one year. There was a higher risk of bleeding more than 1 000 ml after caesarean section (p = 0.01). We found increased neonatal morbidity after vaginal deliveries of breech presentations, but the increase was about the same as that forming the basis for the national guidelines. We therefore choose to continue our practice with recommended vaginal delivery in breech presentation after careful selection.

Évaluation des protocoles de décision de voie d’accouchement en cas de présentation du siège dans 19 CHU en France

Recently, a Belgo-French study led by PREMODA group showed that there was no significant difference between caesarean and vaginal delivery for neonatal outcome. To study protocols and rate of vaginal delivery of single breech in 2006 in the 30 French teaching hospitals that participated to the PREMODA study. Postal survey. Nineteen university hospitals answered (63%). Eighteen used a written protocol and three of them underwent systematic prophylactic caesarean section for breech presentation. Among 15 others, the decision criteria for the way of delivery included pelvimetry, absence of primary cephalic deflexion and foetal measurements. Some centres required additional restrictions. The rates of vaginal delivery varied from 1.7 to 49.7% depending on the centre with very different policies concerning decisional elements. Protocols with restrictions less than three were associated with higher percentages of vaginal delivery (28.9% vs. 21.6%, p<0.001). Most of teaching centres use a written protocol for breech delivery. Huge variations exist between vaginal delivery rates which seems partially linked to the number of restrictions of the protocol. However, criteria used to accept vaginal delivery in breech presentation are variable between centres and do not lie on objective findings.

RETIRED: Vaginal Delivery of Breech Presentation

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