Advertisement

Route of delivery for the breech presentation: A conundrum

  • Daniel P. Eller
    Correspondence
    Reprint requests: Daniel P. Eller, MD, Northside Women's Specialists, 980 Johnson Ferry Road, Suite 620, Atlanta, GA 30342.
    Affiliations
    Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of South Carolina Charleston, South Carolina, USA
    Search for articles by this author
  • J.Peter VanDorsten
    Affiliations
    Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of South Carolina Charleston, South Carolina, USA
    Search for articles by this author
      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      OBJECTIVE: Our purpose was to determine the feasibility of resolving the controversy regarding route of delivery for breech presentation in a randomized, prospective fashion.
      STUDY DESIGN: The National Institute of Child Health and Human Development-sponsored Maternal-Fetal Medicine Units Network, which is composed of 11 perinatal centers, was surveyed to determine the feasibility of a randomized clinical trial of cesarean section versus trial of labor for breech presentation. A review of the literature was performed to determine the experience of other investigators with designing and conducting an adequate prospective, randomized trial.
      RESULTS: Principal investigators and faculty from seven of 11 centers within the Maternal-Fetal Medicine Units Network agreed to participate and felt that they could adequately recruit patients for a trial in very-low-birth-weight infants. This would provide approximately 200 very-low-birth-weight fetuses in a breech presentation per year. Sample size calculations indicated that 1700 infants would be required. Investigators also had strong reservations about performing a trial of vaginal breech delivery for other gestational ages. A review of the literature indicates that other authors have encountered difficulty in attempting randomized clinical trials of this nature.
      CONCLUSIONS: The Maternal-Fetal Medicine Units Network with its pool of 60,000 deliveries per year agreed that a randomized, controlled delivery route of labor in the 24- to 28-week breech presentation was not feasible in a reasonable period of time. A randomized clinical trial of larger fetuses in a breech presentation was also considered extremely difficult. These findings are similar to those of other authors who have attempted or proposed randomized clinical trials to determine the safety of planned vaginal delivery of the breech presentation at various gestational ages.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Wright RC
        Reduction of perinatal mortality and morbidity of breech delivery through routine use of cesarean section.
        Obstet Gynecol. 1959; 14: 758-763
        • Künzel W
        Recommendations of the FIGO Committee on Perinatal Health on guidelines for the management of breech delivery.
        Int J Gynecol Obstet. 1994; 44: 297-300
        • Cheng M
        • Hannah M
        Breech delivery at term: a critical review of the literature.
        Obstet Gynecol. 1993; 82: 605-618
        • Collea JV
        Current management of breech presentation.
        Clin Obstet Gynecol. 1980; 23: 525-531
        • Gimovsky ML
        • Wallace RL
        • Schifrin BS
        • Paul RH
        Randomized management of the non-frank breech presentation at term: a preliminary report.
        Am J Obstet Gynecol. 1983; 46: 34-40
        • Bowes WA
        • Taylor VS
        • O'Brien M
        • Bowes C
        Breech delivery: evaluation of method of delivery on perinatal results and maternal morbidity.
        Am J Obstet Gynecol. 1979; 135: 965-973
        • Main DM
        • Main BK
        • Maurer MM
        Cesarean section versus vaginal delivery for the breech fetus weighing less than 1500 grams.
        Am J Obstet Gynecol. 1983; 46: 580-584
        • Rosen NG
        • Chik L
        Effect of delivery route on outcome breech presentation.
        Am J Obstet Gynecol. 1984; 48: 909-914
        • Olshan AF
        • Shy KK
        • Luthy DA
        • Hickok D
        • Weiss NS
        • Daling JR
        Cesarean birth and neonatal mortality in very low birthweight infants.
        Obstet Gynecol. 1984; 64: 267-270
        • Westgren LMR
        • Songster G
        • Paul RH
        Preterm breech delivery: another retrospective study.
        Obstet Gynecol. 1985; 66: 481-484
        • Gravenhorst JB
        • Schreuder AM
        • Veen S
        • et al.
        Breech delivery in very preterm and very low birthweight infants in the Netherlands.
        Br J Obstet Gynaecol. 1993; 100: 411-415
        • Zlatnik FJ
        The Iowa Premature Breech Trial.
        Am J Perinatol. 1993; 10: 60-63
        • Weiner CP
        Vaginal breech delivery in the 90's.
        Clin Obstet Gynecol. 1992; 35: 559-569
        • Malloy MH
        • Onstad L
        • Wright E
        • National Institute of Child Health and Human Development Neonatal Research Network
        The effect of cesarean delivery on birth outcome in very low birthweight infants.
        Obstet Gynecol. 1991; 77: 498-503
        • Penn ZJ
        • Steer PJ
        Reasons for declining participation in a prospective randomized trial to determine the optimum mode of delivery of the preterm breech.
        Control Clin Trials. 1990; 11: 226-231
        • Penn ZJ
        • Steer PJ
        How obstetricians manage the problem of preterm delivery with special reference to preterm breech.
        Br J Obstet Gynaecol. 1991; 98: 531-534
        • Newman RB
        • Peacock BS
        • VanDorsten JP
        • Hunt HH
        Predicting success of external cephalic version.
        Am J Obstet Gynecol. 1993; 169: 245-250
        • Zhang J
        • Bowes WA
        • Fortney JA
        Efficacy of external cephalic version: a review.
        Obstet Gynecol. 1993; 82: 306-312

      References

        • Chervenak FA
        • Johnson RE
        • Youcha S
        • Hobbins JC
        • Berkowitz RL
        Intrapartum management of twin gestation.
        Obstet Gynecol. 1985; 65: 119-124
        • American College of Obstetricians and Gynecologists
        Management of the breech presentation.
        ACOG Technical Bulleti no 95. 1986; (Washington: American College of Obstetricians and Gynecologists)