Pregnancy outcomes by mode of delivery among breech births.

Department of Obstetrics and Gynecology, Zeynep Kamil Gynecologic and Pediatric Training and Research Hospital, Istanbul 34668, Turkey.
Archives of Gynecology (Impact Factor: 0.91). 07/2011; 285(2):297-303. DOI:10.1007/s00404-011-1956-0
Source: PubMed

ABSTRACT To compare maternal and neonatal outcomes of the vaginal delivery versus cesarean delivery for the breech presentation.
We reviewed the maternal and neonatal charts of all singleton breech deliveries of <1,000, 1,000-1,500, 1,501-2,500, 2,501-4,000, and >4,000 g delivered between 2000 and 2006 at our institution. The study population consisted of 1,537 women with a fetus in a breech presentation. A group of 478 women that had delivered vaginally was compared with a group of 1,059 women, who had cesarean delivery, regarding neonatal mortality and morbidity (asphyxia, bone fractures, intraventricular hemorrhage, convulsions, respiratory distress syndrome, necrotizing enterocolitis, congenital hip dislocation), and maternal morbidity (febrile morbidity, anemia, wound infection).
Neonatal complications did not differ between the group of women with term babies, <1,000 g babies, >1,500 g babies in breech presentation for women that had vaginal delivery and those that had cesarean delivery. On the other hand, breech presentation in preterm delivery between 1,000 and 1,500 g birth weight appears an independent risk factor for the neonatal mortality. There were fewer maternal complications in the vaginal group than in the cesarean group.
Vaginal delivery of 1,000-1,500 g babies presenting as breech is associated with the increased neonatal mortality compared with cesarean delivery. Cesarean delivery is associated with maternal morbidity compared with the vaginal delivery.

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    ABSTRACT: PURPOSE: To assess the accuracy of weight estimation (WE) in fetuses with breech presentation and to compare it directly with a control group of fetuses in vertex presentation. MATERIALS AND METHODS: In a retrospective cohort study, the accuracy of WE in fetuses with breech presentation (n = 244) was evaluated using eight sonographic models and was compared with a control group of fetuses in vertex presentation (n = 244). Each fetus underwent ultrasound examination with complete biometric parameters within 7 days before delivery. The accuracy of the different formulas was compared using means of percentage error (MPE), a measure that reflects systematic error; standard deviation values of MPEs, a measure for random error; medians of absolute percentage error (MAPE), which take both the systematic and random error into account and the percentage of fetal WEs falling within a 10 % range of the actual birth weight. RESULTS: Significantly lower (more negative) MPE values were found in the breech group with the Hadlock (AC, FL) formula, whereas no significant differences were seen with any of the other equations. When compared to zero, in the breech group, a significant systematic error was found with five formulas, while in the control group a significant systematic error was found with three equations. With regard to random error and MAPE, no significant differences were found between the two groups, irrespective of the formula applied. Generally, in both groups, formulas based on three or four biometric indices were more accurate in detecting fetal weight than formulas with only one or two parameters. CONCLUSIONS: Weight estimation in fetuses with breech presentation was as accurate as weight estimation in fetuses with vertex presentation. Using the currently available, well-established formulas should therefore also be appropriate for WE in fetuses with such malpresentations.
    Archives of Gynecology 12/2012; · 0.91 Impact Factor
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    ABSTRACT: Caesarean section incidence is steadily rising worldwide; the major contributor to this rise is pregnancies with previous caesarean section. Hence, it is important to scrutinise carefully the indication of primary caesarean sections. Preterm births, breech presentation and twin pregnancies together complicate 12-18% of all births. The role of caesarean section in these pregnancies is controversial and lacks good evidence-based guidelines. Policy on mode of delivery in these three important obstetric groups is bound to influence overall primary caesarean section rates. In this chapter, we review the evidence on the place of caesarean delivery in these three important groups.
    Best practice & research. Clinical obstetrics & gynaecology 10/2012; · 1.87 Impact Factor
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