Outcomes of Term Vaginal Breech Delivery

University of Houston, Houston, Texas, United States
American Journal of Perinatology (Impact Factor: 1.91). 09/2005; 22(6):325-8. DOI: 10.1055/s-2005-871530
Source: PubMed


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 explore non-clinical maternal and institutional factors associated with the decision for planned cesarean in cases of breech presentation at term in France, where planned vaginal delivery are recommended by the French College of Gynecologists and Obstetricians (CNGOF) when conditions are optimal. The analysis included 6,080 women with a live fetus in breech presentation at term, from the PREMODA prospective survey, in 138 French maternity units between 1 June 2001 and 31 May 2002. Women with previous cesarean sections were excluded. The analysis to identify risk factors for planned cesarean used a multilevel logistic model. The planned cesarean rate was 63.5%. The maternal factors most strongly associated with a decision for planned cesarean were parity (adjusted OR: 2.56 (2.29-2.88)) and maternal age > or =35 years (ORa: 1.38 (1.18-1.61)). No association was found between institutional factors, such as maternity size and level of care, although a centre effect was documented (p<0.001). The variation in planned cesarean rates between maternity units was not associated with their structural characteristics, but was related to a characteristic specific to each centre, and, thus, suggests that despite the current guidelines in France, obstetricians have diverse opinions about the best mode of delivery for breech presentations.
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    ABSTRACT: Breech presentation occurs at term in approximately 3% to 4% of singleton gestations. This presentation is associated with a variety of maternal and fetal conditions including preterm labor, abnormal amniotic fluid volume, hydrocephaly, anencephaly, mullerian anomalies, abnormal placentation, and multifetal gestation. Cesarean delivery has been associated with increased risk of subsequent accreta, placenta previa, hemorrhage, and hysterectomy. The Term Breech Trial initially suggested that planned vaginal breech delivery is associated with increased neonatal morbidity and mortality compared with planned cesarean delivery. Long-term follow-up of these vaginally delivered infants contradict the initial findings. Current debate surrounds the dilemma of whether the untoward complications of cesarean delivery are warranted given uncertain minimal increases in neonatal survival and improvement in neurologic outcome with planned cesarean.
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    ABSTRACT: Objetive: To know Spanish Obstetrics and Gynaecology Society (SEGO) members about cesarean section on request.
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