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Evaluation of a protocol for selecting fetuses in breech presentation for vaginal delivery or cesarean section

      Abstract

      Objective: Our purpose was to evaluate, with respect to obstetric intervention and neonatal outcome, a protocol for selecting fetuses in breech presentation for vaginal delivery or cesarean section. Study design: A clinical follow-up study was performed between 1984 and 1992 of all term singleton deliveries in breech presentation. Each case selected for vaginal delivery had a matched control in vertex presentation. Results: A total of 1212 infants presented as breech. Vaginal delivery increased from 45% to 57% (p = 0.004), and cesarean section for failure of vaginal delivery declined from 21% to 6% (p < 0.00001). None, however, died or had long-term sequelae because of a complicated or failed vaginal breech delivery. A total of 8.8% of those delivered vaginally in breech versus 5.0% of those in vertex presentation were admitted to the neonatal intensive care unit (p = 0.009). Among those with vaginal delivery, 2.5% in breech presentation were given the clinical diagnosis of birth asphyxia versus none in the vertex position (p = 0.0001 ). Conclusion: Breech presentation at term may be selected for vaginal delivery if properly managed.

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      References

        • Thorpe-Beeston JG
        • Banfield PJ
        • StG Saunders NJ
        Outcome of breech delivery at term.
        BMJ. 1992; 305: 746-747
        • Gimovsky ML
        • Wallace RL
        • Schifrin BS
        • Paul RH.
        Randomized management of the nonfrank breech presentation at term: a preliminary report.
        Am J Obstet Gynecol. 1983; 146: 34-40
        • Watson WJ
        • Benson WL.
        Vaginal delivery for the selected frank breech infant at term.
        Obstet Gynecol. 1984; 64: 638-640
        • Collea JV
        • Chein C
        • Quilligan EJ.
        The randomized management of term frank breech presentation: a study of 208 cases.
        Am J Obstet Gynecol. 1980; 137: 235-242
        • Songane FF
        • Thobani S
        • Malik H
        • Bingham P
        • Lilford RJ.
        Balancing the risks of planned cesarean section and trial of vaginal delivery for the mature, selected, singleton breech presentation.
        J Perinat Med. 1987; 15: 531-543
        • Weiner CP.
        Vaginal breech delivery in the 1990s.
        Clin Obstet Gynecol. 1992; 35: 559-569
        • Campbell S
        • Warsof SL
        • Little D
        • Cooper DJ.
        Routine ultrasound screening for the prediction of gestational age.
        Obstet Gynecol. 1983; 146: 613-620
        • Borell U
        • Rådberg C
        Orthodiagraphic pelvimetry with special reference to capacity of distal part of pelvis and pelvic outlet.
        Acta Radiol Diagn. 1962; 2: 273-282
        • Løvset J
        Shoulder delivery by breech presentation.
        J Obstet Gynaecol Br Emp. 1937; 44: 696-704
        • Wright RC.
        Reduction of perinatal mortality and morbidity in breech delivery through routine use of cesarean section.
        Obstet Gynecol. 1959; 14: 758-763
        • Bingham P
        • Hird V
        • Lilford RJ
        Management of the mature selected breech presentation: an analysis based on the intended method of delivery.
        Br J Obstet Gynaecol. 1987; 94: 746-752
        • Gifford DS
        • Morton SC
        • Fiske M
        • Kahn K.
        A meta-analysis of infant outcomes after breech delivery.
        Obstet Gynecol. 1995; 85: 1047-1054
        • Bingham P
        • Lilford RJ.
        Management of the selected term breech presentation: assessment of the risks of selected vaginal delivery versus cesarean section for all cases.
        Obstet Gynecol. 1987; 69: 965-978
        • Feldman GB
        • Freiman JA.
        Prophylactic cesarean section at term.
        N Engl J Med. 1985; 19: 1264-1267
        • Fortney JA
        • Higgins JE
        • Kennedy KI
        • Laufe LE
        • Wilkens L.
        Delivery type and neonatal mortality among 10,749 breeches.
        Am J Public Health. 1986; 76: 980-986
        • Krebs L
        • Langhoff-Roos J
        • Weber T
        Breech at term—mode of delivery? a register-based study.
        Acta Obstet Gynecol Scand. 1995; 74: 702-706
        • Nelson KB
        • Leviton A.
        How much of neonatal encephalopathy is due to birth asphyxia.
        Arch Pediatr Adolesc Med. 1991; 145: 1325-1331
        • Levene MI
        • Sands C
        • Grindulis H
        • Moore JR.
        Comparison of two methods of predicting outcome in perinatal asphyxia.
        Lancet. 1986; 1: 67-69
        • Sykes GS
        • Molloy PA
        • Johnson P
        • Gu W
        • Ashworth F
        • Stirrat GM
        • et al.
        Do Apgar scores indicate asphyxia?.
        Lancet. 1982; 2: 494-496
        • Cahill DJ
        • Turner MJ
        • Stronge JM.
        Breech presentation: is a reduction in traumatic intracranial haemorrhage feasible?.
        J Obstet Gynecol. 1991; 11: 417-419
        • Kiely JL.
        Mode of delivery and neonatal death in 17,587 infants presenting by the breech.
        Br J Obstet Gynaecol. 1991; 98: 898-904
        • Green JE
        • McLean F
        • Smith LP
        • Usher R.
        Has an increased cesarean section rate for term breech delivery reduced the incidence of birth asphyxia, trauma, and death?.
        Am J Obstet Gynecol. 1982; 142: 643-648
        • Tiwary CM.
        Testicular injury in breech delivery: possible implications.
        Pediatr Urol. 1989; 34: 210-212