Outcomes of term vaginal breech delivery
ABSTRACT In December 2001, the American College of Obstetricians and Gynecologists revised their recommendations for breech delivery. These recommendations acknowledge that although a planned vaginal delivery may no longer be appropriate, there are instances in which vaginal breech delivery is inevitable. Moreover, there continues to be patients who for any number of reasons will choose vaginal over cesarean delivery when faced with a fetus in the breech presentation. We sought to review maternal and fetal outcomes in such circumstances when vaginal breech delivery occurs, and compare these outcomes to elective cesarean deliveries for breech presentation. We performed a retrospective review of all singleton breech deliveries at our county hospital from January 2002 through June 2003. We reviewed maternal age, ethnicity, gestational age, gravity, parity, birthweight, mode of delivery, Apgar scores, umbilical arterial blood gases, and maternal and infant complications of both cesarean deliveries and vaginal breech deliveries. Univariate and logistic regression statistical analyses were performed with NCSS software. We had a total of 150 term breech deliveries with gestational ages between 37 and 42 weeks. Of these, 41 were vaginal breech and 109 were cesarean deliveries. Greater than 95% of patients are of Hispanic origin. There were no statistically significant differences in maternal age, ethnicity, gravity, or gestational age. Mean birthweight was significantly lower and parity was significantly higher in the vaginal delivery group. There was also a higher proportion of patients who underwent labor induction/augmentation in the vaginal group. We found no differences in the outcomes of 5-minute Apgar scores, umbilical arterial blood gas values, neonatal intensive care unit admissions, deaths or maternal/fetal complications reported between the two groups. Mean umbilical arterial blood gas values were greater than 7.18 in both groups. Vaginal breech delivery cannot always be avoided. Moreover, at our county hospital several patients continue to choose vaginal breech delivery. Our data would suggest that vaginal breech delivery remains a viable option in selected patients.
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ABSTRACT: To determine whether trainee obstetricians intend to offer vaginal breech delivery once they become certified as specialists and to quantify their experience in vaginal breech delivery. This was an anonymous postal survey of all Australian trainee obstetricians. The survey inquired about experience with, confidence in, and intentions regarding planned vaginal breech delivery after trainees' certification as specialists. Surveys were sent to all 303 Australian registered trainee obstetricians. The response rate was 65%. Experience in vaginal breech delivery increased with year of training, from a median of one delivery for first-year trainees to a median of 12 deliveries for final-year trainees. Although 53% of final-year trainees reported feeling confident with vaginal breech delivery, only 11% reported an intention to offer planned vaginal breech delivery at term as a specialist. Few of the next generation of specialist obstetricians plan to offer vaginal breech delivery to their patients.Obstetrics and Gynecology 11/2007; 110(4):900-3. DOI:10.1097/01.AOG.0000267199.32847.c4 · 4.37 Impact Factor
- Gynécologie Obstétrique & Fertilité 02/2008; 36(1):3-5. DOI:10.1016/j.gyobfe.2007.11.002 · 0.58 Impact Factor
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ABSTRACT: A survey of 100 obstetric trainees was performed to determine the level of experience in vaginal breech delivery (VBD) and external cephalic version (ECV) in the UK. The response rate was 80%. Sixty-four of the respondents were in their 4th or 5th year of old-style 'Calman' specialist registrar training, with the majority having had > or =5 years of experience in obstetrics including overseas experience. A total of 15 had performed less than five, 12 between five and ten, and 53 more than ten VBDs. In spite of limited training, 80% of the trainees felt confident in performing vaginal breech deliveries and were happy to offer VBD as an option in the future. All the respondents offered ECV to their patients and 63% had undergone practical training. Training in VBD should be continued in all settings and it should be a part of routine skills and drills teaching.Journal of Obstetrics and Gynaecology 01/2010; 30(1):10-2. DOI:10.3109/01443610903315629 · 0.60 Impact Factor