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Bevilacqua E, Torcia E, Meli F, Josse J, Bonanni G, Olivier C, Romanzi F, Carlin A, Familiari A, Jani JC, Lanzone A, Badr DA. Maternal and fetal outcomes after planned cesarean or vaginal delivery in twin pregnancy: a comparison between 2 third level birth centers. J Matern Fetal Neonatal Med 2024; 37:2350676. [PMID: 38724257 DOI: 10.1080/14767058.2024.2350676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 04/28/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Twin pregnancy is associated with higher risks of adverse perinatal outcomes for both the mother and the babies. Among the many challenges in the follow-up of twin pregnancies, the mode of delivery is the last but not the least decision to be made, with the main influencing factors being amnionicity and fetal presentation. The aim of the study was to compare perinatal outcomes in two European centers using different protocols for twin birth in case of non-cephalic second twin; the Italian patients being delivered mainly by cesarean section with those in Belgium being routinely offered the choice of vaginal delivery (VD). METHODS This was a dual center international retrospective observational study. The population included 843 women with a twin pregnancy ≥ 32 weeks (dichorionic or monochorionic diamniotic pregnancies) and a known pregnancy outcome. The population was stratified according to chorionicity. Demographic and pregnancy data were reported per pregnancy, whereas neonatal outcomes were reported per fetus. We used multiple logistic regression models to adjust for possible confounding variables and to compute the adjusted odds ratio (adjOR) for each maternal or neonatal outcome. RESULTS The observed rate of cesarean delivery was significantly higher in the Italian cohort: 85% for dichorionic pregnancies and 94.4% for the monochorionic vs 45.2% and 54.4% respectively in the Belgian center (p-value < 0.001). We found that Belgian cohort showed significantly higher rates of NICU admission, respiratory distress at birth and Apgar score of < 7 after 5 min. Despite these differences, the composite severe adverse outcome was similar between the two groups. CONCLUSION In this study, neither the presentation of the second twin nor the chorionicity affected maternal and severe neonatal outcomes, regardless of the mode of delivery in two tertiary care centers, but VD was associated to a poorer short-term neonatal outcome.
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Affiliation(s)
- Elisa Bevilacqua
- Department of Women and Child Health, Women Health Area, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Eleonora Torcia
- Department of Women and Child Health, Women Health Area, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Unit of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Federica Meli
- Department of Women and Child Health, Women Health Area, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Unit of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Juliette Josse
- Department of Obstetrics and Gynaecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Giulia Bonanni
- Department of Women and Child Health, Women Health Area, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Camille Olivier
- Department of Obstetrics and Gynaecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Federica Romanzi
- Department of Women and Child Health, Women Health Area, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Andrew Carlin
- Department of Obstetrics and Gynaecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Alessandra Familiari
- Department of Women and Child Health, Women Health Area, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Jacques C Jani
- Department of Obstetrics and Gynaecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Antonio Lanzone
- Department of Women and Child Health, Women Health Area, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Unit of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Dominique A Badr
- Department of Obstetrics and Gynaecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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Yaouzis Olsson N, Bartfai ED, Åmark H, Wallström T. Outcomes in term breech birth according to intended mode of delivery-A Swedish prospective single-center experience of a dedicated breech birth team. Acta Obstet Gynecol Scand 2024. [PMID: 39129446 DOI: 10.1111/aogs.14945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 07/22/2024] [Accepted: 07/24/2024] [Indexed: 08/13/2024]
Abstract
INTRODUCTION The appropriate mode of delivery for breech babies is a topic of ongoing debate. After the publication of the Term Breech Trial in 2000, the proportion of breech babies delivered vaginally in Sweden rapidly dropped to 7% from 26%. In 2015, international guidelines changed to once again recommend offering vaginal breech deliveries in select cases. In 2017, a Swedish hospital established a dedicated Breech Team to provide safe vaginal breech deliveries according to the new guidelines. The aim of this study is to compare neonatal morbidity in the group planned for cesarean breech delivery with the group planned for vaginal breech delivery treated in accordance with the new guidelines. The study adds to the literature by providing insights into the consequences of reintroducing vaginal breech births in a high-resource health-care setting. MATERIAL AND METHODS A prospective observational study was conducted at Södersjukhuset's maternity ward with 1067 women who gave birth to a single breech fetus at term. Outcomes were compared between the planned vaginal and planned cesarean delivery groups using intention-to-treat analysis and multivariate analysis to control for confounders. RESULTS Out of the 1067 women, 78.9% were planned for cesarean delivery and 21.1% were planned for vaginal delivery. The planned vaginal group had a significantly greater risk for neonatal morbidity compared to the planned cesarean group (3.1% vs. 0.7%; OR 4.44, 95% CI 1.48-13.34). The risk difference remained significant after controlling for confounders. CONCLUSIONS Planned vaginal breech delivery was associated with an increased risk of neonatal mortality and short-term morbidity compared to planned cesarean breech delivery in accordance with the new guidelines. The potential risks and benefits of planned vaginal breech delivery should be carefully weighed against those of planned cesarean delivery.
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Affiliation(s)
- Nicolas Yaouzis Olsson
- Department of Clinical Science and Education, Unit of Obstetrics and Gynecology, Karolinska Institutet, Stockholm, Sweden
| | - Emma Debora Bartfai
- Department of Clinical Science and Education, Unit of Obstetrics and Gynecology, Karolinska Institutet, Stockholm, Sweden
| | - Hanna Åmark
- Department of Clinical Science and Education, Unit of Obstetrics and Gynecology, Karolinska Institutet, Stockholm, Sweden
| | - Tove Wallström
- Department of Clinical Science and Education, Unit of Obstetrics and Gynecology, Karolinska Institutet, Stockholm, Sweden
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Nothelfer A, Friedl TWP, Dayan D, Beer F, Janni W, Reister F, Kraft K, Huener B. Trial and error - Outcome of breech presentation depending on birth mode and root cause analysis of severe adverse events. Eur J Obstet Gynecol Reprod Biol 2024; 299:309-316. [PMID: 38950454 DOI: 10.1016/j.ejogrb.2024.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/16/2024] [Accepted: 06/25/2024] [Indexed: 07/03/2024]
Abstract
OBJECTIVES The debate about the safest birth mode for breech presentation at term remains unresolved. The comparison of a vaginal breech birth (VBB) with an elective caesarean section (CS) regarding fetal outcomes favors the CS. However, the question of whether attempting a VBB is associated with poorer fetal outcomes is examined in this study. Additionally, the study evaluates factors contributing to a successful VBB and illustrates possible errors in VBB management. STUDY DESIGN We performed a retrospective analysis of term breech births over 15 years in a Perinatal Center Level I regarding fetal, maternal, and obstetric outcomes by comparing successful with unsuccessful VBB attempt and all attempted VBB vs. CS including a multivariate analysis of predictors for a successful VBB. A root cause analysis of severe adverse events (SAE) was conducted to evaluate factors leading to poorer fetal outcomes in VBB. RESULTS Of 863 breech cases, in 78 % a CS was performed and in 22 % a VBB was attempted, with 57 % succeeding. Comparing successful with unsuccessful VBB attempts, successful VBB showed significantly lower maternal blood loss (p < 0.001) but poorer umbilical arterial pH (UApH) (p < 0.001), while other fetal outcome parameters showed no significant differences. Predictive factors for a successful VBB attempt were a body mass index (BMI) below 30.0 kg/m2 (p = 0.010) and multiparity (p = 0.003). Comparing all attempted VBB to CS, maternal blood loss was significantly higher in CS (p < 0.001), while fetal outcomes were significantly worse in VBB attempts, included poorer Apgar scores (p < 0.001), poorer UApH values (p < 0.001), higher transfer rate to the Neonatal Intensive Care Unit (NICU) (p < 0.001) and higher rate of respiratory support in the first 24 h (p = 0.003). CONCLUSION The failed attempt of VBB indicates significantly worse UApH without lower Apgar scores or higher transfer rate to the NICU. The likelihood of a successful VBB is 9% lower with obesity and 2.5 times higher in multiparous women. Attempting a VBB should include detailed pre-labor counseling, regarding predictive success factors, an experienced team, and consistent management during birth.
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Affiliation(s)
- Anika Nothelfer
- University Hospital Ulm, Department of Gynecology and Obstetrics, Prittwitzstraße 43, 89075 Ulm, Germany.
| | - Thomas W P Friedl
- University Hospital Ulm, Department of Gynecology and Obstetrics, Prittwitzstraße 43, 89075 Ulm, Germany.
| | - Davut Dayan
- University Hospital Ulm, Department of Gynecology and Obstetrics, Prittwitzstraße 43, 89075 Ulm, Germany.
| | - Franziska Beer
- University Hospital Ulm, Department of Gynecology and Obstetrics, Prittwitzstraße 43, 89075 Ulm, Germany.
| | - Wolfgang Janni
- University Hospital Ulm, Department of Gynecology and Obstetrics, Prittwitzstraße 43, 89075 Ulm, Germany.
| | - Frank Reister
- University Hospital Ulm, Department of Gynecology and Obstetrics, Prittwitzstraße 43, 89075 Ulm, Germany.
| | - Katrina Kraft
- University Hospital Schleswig-Holstein, Department of Gynecology and Obstetrics, Campus Lübeck, Germany.
| | - Beate Huener
- University Hospital Ulm, Department of Gynecology and Obstetrics, Prittwitzstraße 43, 89075 Ulm, Germany.
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DeCicca P, Isabelle M, Malak N. How do physicians respond to new medical research? HEALTH ECONOMICS 2024. [PMID: 38970311 DOI: 10.1002/hec.4879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 06/06/2024] [Accepted: 06/26/2024] [Indexed: 07/08/2024]
Abstract
What happens when the findings of a prominent medical study are overturned? Using a medical trial on breech births, we estimate the effect of the reversal of such a medical study on physician choices and infant health outcomes. Using the United States Birth Certificate Records from 1995 to 2010, we employ a difference-in-differences estimator for C-sections, low Apgar, and low birth weight measures. We find that the reversal of a multi-site, high profile, randomized control trial on the appropriate delivery of term breech births, the Term Breech Trial, led to a 15%-23% decline in C-sections for such births at a time when the overall trend in C-sections was rising. We find our largest estimated effects amongst traditionally disadvantaged groups (i.e., non-white, and minimal education). However, we do not find that such a change in practice had significant impacts on infant health. Contrary to prior studies, we find that physicians updated their beliefs quickly, and do indeed adjust to new medical research, particularly young physicians, prior to mandatory policy or professional guidelines.
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Affiliation(s)
- Philip DeCicca
- Department of Economics, Ball State University, NBER, Muncie, Indiana, USA
| | | | - Natalie Malak
- Department of Economics and Computational Analysis, The University of Alabama in Huntsville, Huntsville, Alabama, USA
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Ebeling AE, Maschke SK, Holthausen-Markou S, Steinkasserer L, Klapdor R, Renz D, Meier N, von Kaisenberg C, Hillemanns P, Brodowski L. The influence of MRI-based pelvimetric measurements in mother's choice of delivery in fetal breech position. Arch Gynecol Obstet 2024:10.1007/s00404-023-07348-3. [PMID: 38334820 DOI: 10.1007/s00404-023-07348-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/14/2023] [Indexed: 02/10/2024]
Abstract
INTRODUCTION At term, about 3-4% of all singleton pregnancies present as breech. MRI-based pelvimetry is a valuable tool to support selection of adequate candidates for a trial-of-labor in women expecting term breech babies. Shared decision-making is playing an increasingly important role in obstetrics. Since the divergent existing knowledge of breech term delivery needs to be discussed with the pregnant woman, we examined the influence of MRI results on the shared decision-making process in women with term breech presentation. METHODS Between 08/2021 and 12/2022, anamnestic and clinical parameters were collected from singleton pregnancies expecting term breech babies resulting in birth at the Hanover Medical School. After information, written consent and inclusion, clinical parameters, the course of birth and the maternal and fetal outcome were collected retrospectively. 32 women participated in a postpartum questionnaire study on inquiry. The subsequent acquisition of information and the arguments in the decision-making process were determined. In addition, the sense of security and self-determination was asked both before and during birth. RESULTS 50% of the respondents had not decided for a mode of delivery before having MRI pelvimetry. After imaging and information, about the own pelvic dimensions and predictors for a successful vaginal birth, 80% of this subgroup decided to give birth vaginally. Over 40% of the collective descripted that they made a decision based on the result of MRI pelvimetry. None of the women felt to be insecure after having talked about the MRI results. The elective cesarean section group and the group of those who delivered vaginally were approximately equally highly satisfied with their feeling of self-determination of the birth mode. Overall, the study population had a very positive birth experience. The group of women who had delivered by elective cesarean showed a wider range in their assessment and appeared to perceive the experience more negative than the group of women who had a vaginal birth or emergency cesarean. Fetal and maternal outcomes did not differ between the groups. DISCUSSION MRT pelvimetry measurements can be used as a predictor for a successful vaginal breech delivery. The additional information obtained from the MRI measurements can be used in the shared decision-making process to decide more easily on the mode of delivery while improving women's awareness and safety. A balanced education on rare and frequently adverse events of vaginal delivery and cesarean section and patient expectations about labor processes must be taken into account.
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Affiliation(s)
- Anna Elisabeth Ebeling
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Sabine Katharina Maschke
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Sophia Holthausen-Markou
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Lena Steinkasserer
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Rüdiger Klapdor
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Diane Renz
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Nina Meier
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Constantin von Kaisenberg
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Peter Hillemanns
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Lars Brodowski
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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Swift B, Taneri B, Cagnan I, Becker CM, Zondervan KT, Quigley MA, Rahmioglu N. Predictors and trends of Caesarean section and breastfeeding in the Eastern Mediterranean region: Data from the cross-sectional Cyprus Women's Health Research (COHERE) Initiative. PLoS One 2023; 18:e0287469. [PMID: 37418433 PMCID: PMC10328327 DOI: 10.1371/journal.pone.0287469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 05/22/2023] [Indexed: 07/09/2023] Open
Abstract
INTRODUCTION Caesarean section (C-section) is a life-saving procedure when medically indicated but unmet need and overuse can add to avoidable morbidity and mortality. It is not clear whether C-section has a negative impact on breastfeeding and there is limited data available on rates of C-section or breastfeeding from Northern Cyprus, an emerging region in Europe. This study aimed to investigate prevalence, trends and associations of C-section and breastfeeding in this population. METHODS Using self-reported data from the representative Cyprus Women's Health Research (COHERE) Initiative, we used 2,836 first pregnancies to describe trends in C-section and breastfeeding between 1981 and 2017. Using modified Poisson regression, we examined the relationship between year of pregnancy and C-section and breastfeeding, as well as the association between C-section and breastfeeding prevalence and duration. RESULTS C-section prevalence in first pregnancies increased from 11.1% in 1981 to 72.5% in 2017 with a relative risk of 2.60 (95%CI; 2.14-2.15) of babies being delivered by C-section after 2005 compared to before 1995, after full adjustment for demographic and maternal medical and pregnancy related factors. Prevalence of ever breastfeeding remained steady throughout the years at 88.7% and there was no significant association between breastfeeding initiation and the year of pregnancy, or demographic and maternal medical and pregnancy related variables. After full adjustment, women who gave birth after 2005 were 1.24 (95%CI; 1.06-1.45) times more likely to breastfeed for >12 weeks compared to women who gave birth before 1995. There was no association between C-section and breastfeeding prevalence or length. CONCLUSION Prevalence of C-section in this population is much higher than WHO recommendations. Public awareness campaigns surrounding choice during pregnancy and change in legal framework to allow for midwife-led continuity models of birthing care should be implemented. Further research is required to understand the reasons and drivers behind this high rate.
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Affiliation(s)
- Bethan Swift
- Oxford Endometriosis CaRe Centre, Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, United Kingdom
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Bahar Taneri
- Faculty of Arts and Sciences, Department of Biological Sciences, Eastern Mediterranean University, Famagusta, Northern Cyprus
- Cyprus Women’s Health Research Society (CoHERS), Nicosia, Northern Cyprus
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research Institute GROW, Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, The Netherlands
| | - Ilgin Cagnan
- Faculty of Arts and Sciences, Department of Biological Sciences, Eastern Mediterranean University, Famagusta, Northern Cyprus
- Cyprus Women’s Health Research Society (CoHERS), Nicosia, Northern Cyprus
| | - Christian M. Becker
- Oxford Endometriosis CaRe Centre, Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Krina T. Zondervan
- Oxford Endometriosis CaRe Centre, Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, United Kingdom
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Maria A. Quigley
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Nilufer Rahmioglu
- Oxford Endometriosis CaRe Centre, Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, United Kingdom
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
- Cyprus Women’s Health Research Society (CoHERS), Nicosia, Northern Cyprus
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Sorensen HA, Obel J, Schroll JB, Krebs L. Breech delivery in low-income settings: A systematic review of perinatal and maternal outcomes in vaginal versus cesarean breech deliveries. Int J Gynaecol Obstet 2023; 161:17-25. [PMID: 36181290 DOI: 10.1002/ijgo.14483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 08/30/2022] [Indexed: 11/11/2022]
Abstract
Most studies comparing vaginal breech delivery (VBD) with cesarean breech delivery (CBD) have been conducted in high-income settings. It is uncertain whether these results are applicable in a low-income setting. To assess the neonatal and maternal mortality and morbidity for singleton VBD compared to CBD in low- and lower-middle-income settings,the PubMed database was searched from January 1, 2000, to January 23, 2020 (updated April 21, 2021). Randomized controlled trials (RCTs) and non-RCTs comparing singleton VBD with singleton CBD in low- and lower-middle-income settings reporting infant mortality were selected. Two authors independently assessed papers for eligibility and risk of bias. The primary outcome was relative risk of perinatal mortality. Meta-analysis was conducted on applicable outcomes. Eight studies (one RCT, seven observational) (12 510 deliveries) were included. VBD increased perinatal mortality (relative risk [RR] 2.67, 95% confidence interval [CI] 1.82-3.91; one RCT, five observational studies, 3289 women) and risk of 5-minute Apgar score below 7 (RR 3.91, 95% CI 1.90-8.04; three observational studies, 430 women) compared to CBD. There was a higher risk of hospitalization and postpartum bleeding in CBD. Most of the studies were deemed to have moderate or serious risk of bias. CBD decreases risk of perinatal mortality but increases risk of bleeding and hospitalization.
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Affiliation(s)
- Herman A Sorensen
- Department of Emergency Medicine, North Zealand Hospital, Copenhagen University Hospital, Hilleroed, Denmark
| | - Josephine Obel
- United Nations Office for Project Services (UNOPS), Access to Health Fund, Yangon, Myanmar
| | - Jeppe B Schroll
- Department of Obstetrics and Gynecology, Copenhagen University Hospital, Amager and Hvidovre Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lone Krebs
- Department of Obstetrics and Gynecology, Copenhagen University Hospital, Amager and Hvidovre Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Ho AK, Zamperoni KE, Ho AMH, Mizubuti GB. Introducing the fragility index-A case study using the Term Breech Trial. Birth 2023; 50:11-15. [PMID: 36576726 DOI: 10.1111/birt.12698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 11/02/2022] [Accepted: 11/21/2022] [Indexed: 12/29/2022]
Abstract
The fragility index (FI) is a sensitivity analysis of the statistically significant result of a clinical study. It is the number of hypothetical changes in the primary event of one of the two cohorts in a 1-to-1 comparative trial to render the statistically significant result non-significant (ie, to alter the P-value from ≤0.05 to >0.05). The FI can be compared with the patient drop-out rates and protocol violations, which, if much higher than the FI, may arguably suggest less robustness/stability of the trial's results. To illustrate the concept, we have chosen the Term Breech Trial (TBT) as a case study. The TBT results favor planned cesarean birth, as opposed to planned vaginal delivery, in the term singleton fetus with breech presentation. Our analysis shows that the FI of the TBT is 21, which is small in comparison to the number (hundreds) of protocol violations present. Some experts have suggested the inclusion of the FI in data analysis and subsequent discussion of clinical trial data. Routine use of such a metric may be valuable in encouraging readers to maintain a healthy degree of skepticism, especially when interpreting trial results which may directly influence clinical practice.
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Affiliation(s)
- Adrienne K Ho
- Department of Public Health Sciences (Epidemiology), Queen's University School of Medicine, Kingston, Ontario, Canada
| | | | - Anthony M H Ho
- Department of Anesthesiology and Perioperative Medicine, Queen's University School of Medicine, Kingston, Ontario, Canada
| | - Glenio B Mizubuti
- Department of Anesthesiology and Perioperative Medicine, Queen's University School of Medicine, Kingston, Ontario, Canada
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Panda S, Begley C, Daly D. Clinicians' views of factors influencing decision-making for CS for first-time mothers-A qualitative descriptive study. PLoS One 2022; 17:e0279403. [PMID: 36576912 PMCID: PMC9797090 DOI: 10.1371/journal.pone.0279403] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 12/07/2022] [Indexed: 12/29/2022] Open
Abstract
Clinicians' perspectives of the reasons for performing caesarean section (CS) are fundamental to deepening knowledge and understanding of factors influencing decision-making for CS. The aim of this study was to explore midwives' and obstetricians' views of factors influencing decision-making for CS for first-time mothers. A qualitative descriptive study with semi-structured one-to-one audio-recorded interviews was used to gather data from clinicians (15 midwives and 20 senior obstetricians). Following research ethics committee approval, clinicians, who were directly involved in the decision-making process for CS during the period of data collection, were purposively selected from three maternity units in the Republic of Ireland between June 2016 to July 2017. The interviews were transcribed verbatim and analysed thematically. Three interrelated themes with several subthemes reflective of clinicians' views and experiences emerged following data analysis. These were: 'A fear factor' describing clinicians' fear of adverse outcomes and subsequent litigation, 'Personal preferences versus a threshold-clinician driven factors emphasising the influence of clinicians' personal beliefs, and 'Standardised versus individualised care-a system perspective' explaining the effects of, or lack of, organisational policy and its direct and indirect impact on the decision-making process. Findings show that decisions to perform a CS are, on occasion, based on clinicians' personal beliefs and interpretation, similar to findings from other published literature. Consideration of broader issues related to organisational, socio-cultural and political context is essential when seeking solutions to the rising CS rates. The findings will enable clinicians to reflect on their day-to-day practice, in order to look for modifiable factors that influence their decision-making, and help women understand the multitude of factors that can lead to a decision to perform a CS. Findings will also contribute to the development of the 'next step action' and assist in devising future intervention studies to reduce any unnecessary CSs.
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Affiliation(s)
- Sunita Panda
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
- * E-mail:
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Deirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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Fruscalzo A, Londero AP, Gerleve H, Riedel N, Jaspers KD. Short-term neonatal outcomes in vaginal breech delivery: Results of a retrospective single-centre study. Eur J Obstet Gynecol Reprod Biol 2022; 279:122-129. [DOI: 10.1016/j.ejogrb.2022.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/06/2022] [Accepted: 10/25/2022] [Indexed: 11/25/2022]
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Bevilacqua E, Jani JC, Meli F, Carlin A, Bonanni G, Rimbault M, Ruggiano I, Quenon C, Romanzi F, Lanzone A, Badr DA. Pregnancy outcomes in breech presentation at term: a comparison between 2 third level birth center protocols. AJOG GLOBAL REPORTS 2022; 2:100086. [DOI: 10.1016/j.xagr.2022.100086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
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Fernández-Carrasco FJ, Cristóbal-Cañadas D, Gómez-Salgado J, Vázquez-Lara JM, Rodríguez-Díaz L, Parrón-Carreño T. Maternal and fetal risks of planned vaginal breech delivery vs planned caesarean section for term breech birth: A systematic review and meta-analysis. J Glob Health 2022; 12:04055. [PMID: 35976004 PMCID: PMC9284475 DOI: 10.7189/jogh.12.04055] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Breech presentation delivery approach is a controversial issue in obstetrics. How to cope with breech delivery (vaginal or C-section) has been discussed to find the safest in terms of morbidity. The aim of this study was to assess the risks of foetal and maternal mortality and perinatal morbidity associated with vaginal delivery against elective caesarean in breech presentations, as reported in observational studies. Methods Studies assessing perinatal morbidity and mortality associated with breech presentations births. Cochrane, Medline, Scopus, Embase, Web of Science, and Cuiden databases were consulted. This protocol was registered in PROSPERO CRD42020197598. Selection criteria were: years between 2010 and 2020, in English language, and full-term gestation (37-42 weeks). The methodological quality of the eligible articles was assessed according to the Newcastle-Ottawa scale. Meta-analyses were performed to study each parameter related to neonatal mortality and maternal morbidity. Results The meta-analysis included 94 285 births with breech presentation. The relative risk of perinatal mortality was 5.48 (95% confidence interval (CI) = 2.61-11.51) times higher in the vaginal delivery group, 4.12 (95% CI = 2.46-6.89) for birth trauma and 3.33 (95% CI = 1.95-5.67) for Apgar results. Maternal morbidity showed a relative risk 0.30 (95% CI = 0.13-0.67) times higher in the planned caesarean group. Conclusions An increment in the risk of perinatal mortality, birth trauma, and Apgar lower than 7 was identified in planned vaginal delivery. However, the risk of severe maternal morbidity because of complications of a planned caesarean was slightly higher.
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Affiliation(s)
- Francisco J Fernández-Carrasco
- Department of Gynaecology and Obstetrics, Punta de Europa Hospital, Cádiz, Spain
- Nursing and Physiotherapy Department, Faculty of Nursing, University of Cádiz, Algeciras, Spain
| | - Delia Cristóbal-Cañadas
- Neonatal and Paediatric Intensive Care Unit, Torrecárdenas University Hospital, Almeria, Spain
| | - Juan Gómez-Salgado
- Department of Gynaecology and Obstetrics, Ceuta University Hospital, Midwifery Teaching Unit of Ceuta, University of Granada, Ceuta, Spain
- Safety and Health Postgraduate Programme, Espíritu Santo University, Guyaquil, Ecuador
| | - Juana M Vázquez-Lara
- Department of Gynaecology and Obbstetrics, Ceuta University Hospital, Midwifery Teaching Unit of Ceuta, University of Granada, Ceuta, Spain
| | - Luciano Rodríguez-Díaz
- Department of Gynaecology and Obbstetrics, Ceuta University Hospital, Midwifery Teaching Unit of Ceuta, University of Granada, Ceuta, Spain
| | - Tesifón Parrón-Carreño
- School of Health Sciences, University of Almeria, Almeria, Spain
- Territorial Delegation of Equality, Health and Social Policies, Health Delegation of Almeria, Almeria, Spain
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13
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Toijonen A, Heinonen S, Gissler M, Macharey G. Neonatal outcome in vaginal breech labor at 32 + 0-36 + 0 weeks of gestation: a nationwide, population-based record linkage study. BMC Pregnancy Childbirth 2022; 22:211. [PMID: 35296277 PMCID: PMC8928595 DOI: 10.1186/s12884-022-04547-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 03/07/2022] [Indexed: 11/25/2022] Open
Abstract
Background In many countries, vaginal breech labor at term is an option in selected cases. However, the safety of vaginal breech labor in preterm is still unclear. Therefore our study aimed to evaluate the safety of vaginal breech labor in late preterm deliveries. Design A retrospective register-based study. Setting Maternity hospitals in Finland, 2004–2017. Participants The study population included 762 preterm breech deliveries at 32 + 0—36 + 6 gestational weeks according to the mode of delivery, 535 (70.2%) of them were born vaginally in breech presentation, and 227 (29.8%) were delivered by non-urgent cesarean section. Methods The study compared short-term neonatal adverse outcomes of singleton vaginal breech deliveries with non-urgent cesarean deliveries at 32 + 0 to 36 + 6 weeks of gestation. An odd ratio with 95% confidence intervals was calculated to estimate the relative risk of adverse outcomes. Outcome measures Neonatal death, an arterial umbilical pH below seven, a five-minute Apgar score below four and seven, admission to neonatal intensive care unit, neonatal intubation, neonatal antibiotic therapy, neonatal birth trauma, respiratory distress syndrome, neonatal convulsions, cerebral ischemia, hypoxic-ischemic encephalopathy, congenital hypotonia, and a composite of severe adverse outcomes. Results A five-minute Apgar scores below seven were increased in vaginal breech labor at 32 + 0 to 36 + 6 weeks of gestation compared to non-urgent cesarean sections (aOR 2.48, 95% CI 1.08–5.59). Neonatal antibiotic therapy, the admission to neonatal intensive care unit, and neonatal respiratory distress syndrome were decreased after vaginal breech labor compared to the outcomes of non-urgent cesarean section (neonatal antibiotic therapy aOR 0.60, 95% CI 0.40–0.89; neonatal NICU admission aOR 0.47, 95% CI 0.33–0.68; respiratory distress syndrome aOR 0.30, 95% CI 0.19–0.48). Conclusion Vaginal breech labor at 32 + 0—36 + 6 gestational weeks does not increase severe neonatal short-term morbidity or mortality compared to cesarean section.
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Affiliation(s)
| | - Seppo Heinonen
- Department of Obstetrics and Gynecology, University Hospital (HUS), University of Helsinki, Haartmaninkatu 2, 00290, Helsinki, Finland
| | - Mika Gissler
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Georg Macharey
- Department of Obstetrics and Gynecology, University Hospital (HUS), University of Helsinki, Haartmaninkatu 2, 00290, Helsinki, Finland
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Affiliation(s)
| | - Kenneth C Johnson
- School of Epidemiology and Public Health, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Casteels M, Podevyn K, Vanoverschelde H, Louwen F. Implementation of a breech program in a Belgian obstetric team. Int J Gynaecol Obstet 2021; 158:432-438. [PMID: 34735728 DOI: 10.1002/ijgo.14003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 10/25/2021] [Accepted: 11/02/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To stimulate obstetric centers to start training in breech counseling and selection and performing vaginal breech deliveries. METHODS The different steps that were needed to roll out a breech program, are described: the "walking" epidural (PIEB protocol), the breech consultation with a structured counseling tool, and training of the whole team (gynecologists, midwives, anesthesiologists, and pediatricians). We describe below the results of 111 women who were counseled at the breech consultation, in the period May 2019 to August 2021. RESULTS In all, 86.5% of patients (n= 96) with a singleton term breech met the criteria for a vaginal breech delivery; 77% of this group (n= 74) accepted a planned vaginal breech delivery. Of this group, 54% (n=40) had a successful vaginal breech delivery, 27% (n=20) ended up in a secondary cesarean section, and 19% (n=14) had a planned cesarean section. CONCLUSION We were able to roll out a successful breech program, including vaginal breech delivery, in a safe way. The breech consultation is the most essential part of the process. Training of the whole team is mandatory. The results of the first 2 years are encouraging to continue this program.
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Affiliation(s)
- Martine Casteels
- Department of Gynecology and Obstetrics, AZ Maria Middelares, Ghent, Belgium
| | - Kathleen Podevyn
- Department of Gynecology and Obstetrics, AZ Maria Middelares, Ghent, Belgium
| | | | - Frank Louwen
- Department of Gynecology and Obstetrics, Goethe-University Hospital, Frankfurt, Germany
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Evaluación del conocimiento de la versión cefálica externa y de las preferencias sobre el manejo de la presentación podálica a término entre mujeres en edad fértil. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2021. [DOI: 10.1016/j.gine.2021.100680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Gunay T, Turgut A, Demircivi Bor E, Hocaoglu M. Comparison of maternal and fetal complications in pregnant women with breech presentation undergoing spontaneous or induced vaginal delivery, or cesarean delivery. Taiwan J Obstet Gynecol 2021; 59:392-397. [PMID: 32416886 DOI: 10.1016/j.tjog.2020.03.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Breech presentation is the most common form of malpresentation, and associated with perinatal asphyxia and mortality, and maternal morbidity. Data associated with labor induction in breech presentation are limited. The aim of this study was to compare maternal and fetal complication rates in induced and spontaneous vaginal, and cesarean delivery with breech presentation. MATERIALS AND METHODS Pregnant women with breech presentation were grouped: spontaneous vaginal delivery (Group 1, n = 72) induced or augmented vaginal delivery (Group 2, n = 32), and cesarean delivery (Group 3, n = 253). Fetal complications were as follows: clavicle fracture, femur fracture, humerus fracture, brachial plexus injury, cephalic hematoma, pneumothorax, need for intensive care unit (ICU), and 5th minute APGAR <7. Maternal complications were as follows: vaginal hematoma, deep vaginal laceration, perineal injury (≥3rd degree), decline in hemoglobin level (>2 g/dL), and postpartum endometritis. Data were collected and analyzed retrospectively. RESULTS The highest fetal complication rate was in Group 2, and the lowest in Group 3 (p = 0.001). Clavicle fracture was significantly less in Group 3 compared with the other groups (p = 0.024). The rate of lower APGAR scores at the 5th minute was similar in all groups. Maternal complications were significantly higher in Group 2 compared with the other groups (p = 0.001). Fetal complications were 5.66-fold higher in Group 1 than in Group 3 (p = 0.002). Fetal and maternal complications were 9.48-fold and 7.48-fold higher, respectively, in Group 2 than in Group 3 (p < 0.001). CONCLUSION This study is the first in literature to have investigated and analyzed neonatal complications in breech delivery according to different delivery modes including induced vaginal delivery. Due to possible complications, the risks and benefits of a specific type of delivery should be considered in breech presentation.
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Affiliation(s)
- Taner Gunay
- Department of Obstetrics and Gynecology, Istanbul Medeniyet University Goztepe Education and Research Hospital, Doktor Erkin caddesi, Kadıkoy/Istanbul, Turkey.
| | - Abdulkadir Turgut
- Department of Obstetrics and Gynecology, Istanbul Medeniyet University Goztepe Education and Research Hospital, Doktor Erkin caddesi, Kadıkoy/Istanbul, Turkey.
| | - Ergul Demircivi Bor
- Department of Obstetrics and Gynecology, Istanbul Medeniyet University Goztepe Education and Research Hospital, Doktor Erkin caddesi, Kadıkoy/Istanbul, Turkey.
| | - Meryem Hocaoglu
- Department of Obstetrics and Gynecology, Istanbul Medeniyet University Goztepe Education and Research Hospital, Doktor Erkin caddesi, Kadıkoy/Istanbul, Turkey.
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Correia Costa S, Raposo MI, Machado AP, Ramalho C, Ayres-de-Campos D, Montenegro N. External cephalic version: Predictors of success and influence on caesarean rates. Eur J Obstet Gynecol Reprod Biol 2020; 256:211-214. [PMID: 33248375 DOI: 10.1016/j.ejogrb.2020.11.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/05/2020] [Accepted: 11/11/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the success rate of external cephalic version, predictive factors for success of this maneuver and to examine how it affects mode of delivery, pregnancy and neonatal outcome rates. STUDY DESIGN Retrospective cross-sectional study performed in a tertiary care university hospital between January 2002 and June 2018. A total of 324 ECVs were performed in 321 pregnancies. Maternal and ultrasound data, procedure-related factors, birth characteristics and neonatal data were collected. Absolute and relative frequencies were used for descriptive analysis and the chi-square test for comparative analysis. Odds ratios with 95 % confidence intervals were calculated. RESULTS The overall success rate of the procedure was 33,3%. Multiparity, transverse lie, unengaged breech presentation, low body mass index, soft uterus and palpable fetal head were independent risk factors for success. No statistically significant association was found with other variables. Routine use of ECV allowed a reduction in cesarean delivery rates for breech presentation, with no increase in maternal or neonatal morbidity. Operative delivery rates after successful ECV were similar to those of the general population. DISCUSSION AND CONCLUSION Despite a relatively low overall success rate, routine use of ECV can result in reduced cesarean delivery rates with similar perinatal outcomes. Conveyed information on the success rate of ECV can be adapted to individual patient characteristics.
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Affiliation(s)
- Susana Correia Costa
- Department of Obstetrics, Centro Hospitalar Universitário São João, Porto, Portugal.
| | - Maria Inês Raposo
- Department of Obstetrics and Gynecology, Hospital Divino Espírito Santo, Ponta Delgada, Azores, Portugal
| | - Ana Paula Machado
- Department of Obstetrics, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Carla Ramalho
- Department of Obstetrics, Centro Hospitalar Universitário São João, Porto, Portugal; Faculty of Medicine, University of Porto, Portugal; Health Innovation and Investigation Institute, University of Porto, Portugal
| | - Diogo Ayres-de-Campos
- Department of Obstetrics, Centro Hospitalar Lisboa Norte, Portugal; Faculty of Medicine, University of Lisbon, Portugal
| | - Nuno Montenegro
- Department of Obstetrics, Centro Hospitalar Universitário São João, Porto, Portugal; Faculty of Medicine, University of Porto, Portugal
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Pulido Valente M, Carvalho Afonso M, Clode N. Is Vaginal Breech Delivery Still a Safe Option? REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2020; 42:712-716. [PMID: 33254265 PMCID: PMC10309230 DOI: 10.1055/s-0040-1713804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 05/07/2020] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To determine whether there was any difference in neonatal and maternal outcomes between breech vaginal delivery and cephalic vaginal delivery. METHODS A retrospective, case-control study was conducted between January 2015 and December 2017 in a Portuguese hospital. A total of 26 cases of breech vaginal delivery were considered eligible and 52 pregnant women formed the control group. RESULTS Induced labor was more frequent in the breech vaginal delivery group (46% versus 21%, p = 0.022). Episiotomy was more common in the breech vaginal delivery group (80% versus 52%, p = 0.014), and one woman had a 3rd degree perineal laceration. Newborns in the study group had a lower birthweight (2,805 g versus 3,177 g, p < 0.001). There was no significant difference in the neonatal outcomes. CONCLUSION The present study showed that breech vaginal delivery at term compared with cephalic presentation was not associated with significant differences in neonatal and maternal morbidity. It also suggests that breech vaginal delivery remains a safe option under strict selection criteria and in the presence of an experienced obstetrician.
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Affiliation(s)
- Maria Pulido Valente
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - Maria Carvalho Afonso
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - Nuno Clode
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
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20
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Martel-Santiago CR, Arencibia-Díaz RD, Romero-Requejo A, Valle-Morales L, Figueras-Falcón T, García-Hernández JÁ, Martin-Martinez A. Delivery in breech presentation: Perinatal outcome and neurodevelopmental evaluation at 18 months of life. Eur J Obstet Gynecol Reprod Biol 2020; 255:147-153. [PMID: 33130377 DOI: 10.1016/j.ejogrb.2020.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 10/06/2020] [Accepted: 10/09/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To compare maternal and perinatal outcomes, including neurodevelopmental results at 18 months of life, between term breech and cephalic deliveries. STUDY DESIGN In this longitudinal retrospective study of mothers seen at the Maternity and Paediatric University Hospital of the Canary Islands delivery unit from November 1, 2011, to October 31, 2012, we compared maternal and perinatal outcomes associated with breech or cephalic presentation of the foetus. A second analysis was performed to compare breech births, differentiating between whether a vaginal delivery attempt was made or if caesarean section (C-section) without labour had been directly scheduled. The psychomotor development of children 18 months after birth was assessed using the Haizea-Llevant scale. RESULTS A total of 130 breech deliveries were matched with 130 cephalic deliveries. No perinatal mortality occurred in either group. The C-section percentage was greater in the breech presentation group compared with the cephalic delivery group (72.3 % vs. 14.6 %; p < 0.001). Children in the breech presentation had a threefold increased risk for Apgar scores <7 at 1 min (OR 3.2; 95 % CI: 1.2-8.4; p = 0.016) compared with cephalic presentation. These differences disappeared 5 min after birth. No differences were observed in moderate to severe neonatal morbidity between the breech and cephalic presentation groups. There were no differences between groups in neurodevelopmental outcomes. Of 130 pregnancies with breech presentation, 79 (60.8 %) made a vaginal delivery attempt, and 51 (39.2 %) were planned C-sections. Women who attempted vaginal breech delivery were younger and had a history of previous pregnancy. Apgar scores <7 at 1 min were more frequent in the vaginal delivery attempt group (27.9 % vs. 5.9 %; p = 0.002). A high percentage of type III resuscitation (36.5 % vs. 14.3 %; p = 0.007) and Neonatology admission (22.8 % vs. 5.9 %; p = 0.013) was observed in the vaginal delivery attempt group. Except for Apgar scores <7 at 1 min, none of these associations was significant after adjusting for nulliparity and maternal age. The mode of delivery was not associated with moderate to severe perinatal outcomes. CONCLUSION The implementation of a specific protocol for selecting pregnant women with breech presentation as candidates for vaginal delivery achieved perinatal outcomes similar to births in cephalic presentation.
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Affiliation(s)
- Carmen Rosa Martel-Santiago
- Maternal-Fetal Unit and Obstetrics and Gynaecology Unit, Complejo Hospitalario Universitario Insular-Materno Infantil de Canarias, Spain
| | | | - Azahar Romero-Requejo
- Maternal-Fetal Unit and Obstetrics and Gynaecology Unit, Complejo Hospitalario Universitario Insular-Materno Infantil de Canarias, Spain
| | - Leonor Valle-Morales
- Maternal-Fetal Unit and Obstetrics and Gynaecology Unit, Complejo Hospitalario Universitario Insular-Materno Infantil de Canarias, Spain
| | - Tatiana Figueras-Falcón
- Maternal-Fetal Unit and Obstetrics and Gynaecology Unit, Complejo Hospitalario Universitario Insular-Materno Infantil de Canarias, Spain
| | - José Ángel García-Hernández
- Maternal-Fetal Unit and Obstetrics and Gynaecology Unit, Complejo Hospitalario Universitario Insular-Materno Infantil de Canarias, Spain
| | - Alicia Martin-Martinez
- Maternal-Fetal Unit and Obstetrics and Gynaecology Unit, Complejo Hospitalario Universitario Insular-Materno Infantil de Canarias, Spain.
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Derisbourg S, Costa E, De Luca L, Amirgholami S, Bogne Kamdem V, Vercoutere A, Zhang WH, Alexander S, Buekens PM, Englert Y, Pintiaux A, Daelemans C. Impact of implementation of a breech clinic in a tertiary hospital. BMC Pregnancy Childbirth 2020; 20:435. [PMID: 32727421 PMCID: PMC7391516 DOI: 10.1186/s12884-020-03122-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 07/21/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The incidence of breech presentation in single pregnancies at term is between three to 5 %. In order to support eligible women in their choice of mode of delivery, a dedicated breech clinic with a care pathway was developed in December 2015 in a tertiary referral centre in Brussels. The primary objective of this study was to evaluate the vaginal birth rate before and after the introduction of a dedicated breech clinic. The secondary objective was to compare the early neonatal outcomes before and after the breech clinic was introduced. METHODS This was a single centre retrospective and prospective study. The inclusion criteria were term (from 37 weeks), singleton fetus and breech presentation at delivery. The exclusion criteria were suspected intrauterine growth restriction, severe fetal malformations and intrauterine fetal demise. We used a composite outcome as an indicator of neonatal morbidity and mortality. RESULTS After the introduction of the breech clinic, we observed a significant increase in planned vaginal delivery from 7.4% (12/162) to 53.0% (61/115) (OR: 13.5; 95% CI: 6.7-27.0). The effective vaginal breech delivery rate (planned and unexpected) significantly increased from 4.3% (7/162) pre-implementation of breech clinic to 43.5% (50/115) post-implementation (OR: 17.0; 95% CI: 7.3-39.6). Neonatal outcomes were not statistically different between the before and after periods. CONCLUSION The introduction of a dedicated breech clinic has led to an increase in vaginal deliveries for breech babies without adversely affecting neonatal outcomes.
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Affiliation(s)
- S Derisbourg
- Department of Obstetrics and Gynecology, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Université Libre de Bruxelles (ULB), 808 route de Lennik, B-1070, Bruxelles, Belgium.
| | - E Costa
- Department of Obstetrics and Gynecology, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Université Libre de Bruxelles (ULB), 808 route de Lennik, B-1070, Bruxelles, Belgium
| | - L De Luca
- Department of Obstetrics and Gynecology, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Université Libre de Bruxelles (ULB), 808 route de Lennik, B-1070, Bruxelles, Belgium
| | - S Amirgholami
- Department of Obstetrics and Gynecology, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Université Libre de Bruxelles (ULB), 808 route de Lennik, B-1070, Bruxelles, Belgium
| | - V Bogne Kamdem
- Department of Obstetrics and Gynecology, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Université Libre de Bruxelles (ULB), 808 route de Lennik, B-1070, Bruxelles, Belgium
| | - A Vercoutere
- Department of Obstetrics and Gynecology, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Université Libre de Bruxelles (ULB), 808 route de Lennik, B-1070, Bruxelles, Belgium
| | - W H Zhang
- Research Laboratory for Human Reproduction, Faculty of Medicine, Université Libre de Bruxelles (ULB), 808 route de Lennik, CP 597, B-1070, Bruxelles, Belgium
| | - S Alexander
- Perinatal Epidemiology and Reproductive Health Unit, Epidemiology, Biostatistics and Clinical Research Centre, Ecole de Santé Publique, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - P M Buekens
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Y Englert
- Department of Obstetrics and Gynecology, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Université Libre de Bruxelles (ULB), 808 route de Lennik, B-1070, Bruxelles, Belgium
- Research Laboratory for Human Reproduction, Faculty of Medicine, Université Libre de Bruxelles (ULB), 808 route de Lennik, CP 597, B-1070, Bruxelles, Belgium
| | - A Pintiaux
- Department of Obstetrics and Gynecology, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Université Libre de Bruxelles (ULB), 808 route de Lennik, B-1070, Bruxelles, Belgium
| | - C Daelemans
- Department of Obstetrics and Gynecology, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Université Libre de Bruxelles (ULB), 808 route de Lennik, B-1070, Bruxelles, Belgium
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Attitudes towards breech management among a team of maternity clinicians in Australia undertaking breech training. Women Birth 2020; 33:e348-e356. [DOI: 10.1016/j.wombi.2019.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 08/05/2019] [Accepted: 08/05/2019] [Indexed: 11/21/2022]
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Leeman L. State of the breech in 2020: Guidelines support maternal choice, but skills are lost…. Birth 2020; 47:165-168. [PMID: 32128861 DOI: 10.1111/birt.12487] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/08/2020] [Accepted: 02/08/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Lawrence Leeman
- Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico.,Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque, New Mexico
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Carbillon L, Benbara A, Tigaizin A, Murtada R, Fermaut M, Belmaghni F, Bricou A, Boujenah J. Revisiting the management of term breech presentation: a proposal for overcoming some of the controversies. BMC Pregnancy Childbirth 2020; 20:263. [PMID: 32359354 PMCID: PMC7196223 DOI: 10.1186/s12884-020-2831-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 02/20/2020] [Indexed: 11/29/2022] Open
Abstract
Background The debate surrounding the management of term breech presentation has excessively focused on the mode of delivery. Indeed, a steady decline in the rate of vaginal breech delivery has been observed over the last three decades, and the soundness of the vaginal route was seriously challenged at the beginning of the 2000s. However, associations between adverse perinatal outcomes and antenatal risk factors have been observed in foetuses that remain in the breech presentation in late gestation, confirming older data and raising the question of the role of these antenatal risk factors in adverse perinatal outcomes. Thus, aspects beyond the mode of delivery must be considered regarding the awareness and adequate management of such situations in term breech pregnancies. Main body In the context of the most recent meta-analysis and with the publication of large-scale epidemiologic studies from medical birth registries in countries that have not abruptly altered their criteria for individual decision-making regarding the breech delivery mode, the currently available data provide essential clues to understanding the underlying maternal-foetal conditions beyond the delivery mode that play a role in perinatal outcomes, such as foetal growth restriction and gestational diabetes mellitus. In view of such data, an accurate evaluation of these underlying conditions is necessary in cases of persistent term breech presentation. Timely breech detection, estimated foetal weight/growth curves and foetal/maternal well-being should be considered along with these possible antenatal risk factors; a thorough analysis of foetal presentation and an evaluation of the possible benefit of external cephalic version and pelvic adequacy in each specific situation of persistent breech presentation should be performed. Conclusion The adequate management of term breech pregnancies requires screening and the efficient identification of breech presentation at 36 weeks of gestation, followed by thorough evaluations of foetal weight, growth and mobility, while obstetric history, antenatal gestational disorders and pelvis size/conformation are considered. The management plan, including external cephalic version and follow-up based on the maternal/foetal condition and potentially associated disorders, should be organized on a case-by-case basis by a skilled team after the woman is informed and helped to make a reasoned decision regarding delivery route.
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Affiliation(s)
- Lionel Carbillon
- Department of Obstetrics and Gynecology, Sorbonne Paris Nord University, Assistance Publique - Hopitaux de Paris, Avenue du 14 juillet, Hôpital Jean Verdier, 93140, Bondy Cedex, France. .,Department of Obstetrics and Gynecology, Assistance Publique - Hôpitaux de Paris, Hôpital Jean Verdier, Bondy, France.
| | - Amelie Benbara
- Department of Obstetrics and Gynecology, Assistance Publique - Hôpitaux de Paris, Hôpital Jean Verdier, Bondy, France
| | - Ahmed Tigaizin
- Department of Obstetrics and Gynecology, Assistance Publique - Hôpitaux de Paris, Hôpital Jean Verdier, Bondy, France
| | - Rouba Murtada
- Department of Obstetrics and Gynecology, Assistance Publique - Hôpitaux de Paris, Hôpital Jean Verdier, Bondy, France
| | - Marion Fermaut
- Department of Obstetrics and Gynecology, Assistance Publique - Hôpitaux de Paris, Hôpital Jean Verdier, Bondy, France
| | - Fatma Belmaghni
- Department of Obstetrics and Gynecology, Assistance Publique - Hôpitaux de Paris, Hôpital Jean Verdier, Bondy, France
| | - Alexandre Bricou
- Department of Obstetrics and Gynecology, Assistance Publique - Hôpitaux de Paris, Hôpital Jean Verdier, Bondy, France
| | - Jeremy Boujenah
- Department of Obstetrics and Gynecology, Assistance Publique - Hôpitaux de Paris, Hôpital Jean Verdier, Bondy, France
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Visser GHA. Trial of vaginal breech delivery in carefully selected women is worth considering-Fruit for thought! Eur J Obstet Gynecol Reprod Biol 2020; 252:574-575. [PMID: 32279984 DOI: 10.1016/j.ejogrb.2020.03.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 03/24/2020] [Indexed: 11/30/2022]
Abstract
There remains uncertainty about the optimal route of delivering carefully selected breech babies at term. This review argues strongly that vaginal mode of delivery should be considered in selected cases rather than offering an elective caesarean section for every patient.
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Affiliation(s)
- Gerard H A Visser
- Department of Obstetrics, University Medical Center, Utrecht, the Netherlands.
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Bautista-Charry AA, Grillo-Ardila CF. VAGINAL TERM BREECH DELIVERY, A FOOLHARDY OPTION OR AN OPPORTUNITY? REVISTA COLOMBIANA DE OBSTETRICIA Y GINECOLOGÍA 2020; 70:215-218. [PMID: 32142236 DOI: 10.18597/rcog.3483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - Carlos Fernando Grillo-Ardila
- Profesor Asistente, Departamento de Obstetricia y Ginecología, Facultad de Medicina, Universidad Nacional de Colombia
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Breech deliveries in OLVG, the Netherlands: A retrospective cohort study of seven years. Eur J Obstet Gynecol Reprod Biol 2020; 248:37-43. [PMID: 32193024 DOI: 10.1016/j.ejogrb.2020.02.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/19/2020] [Accepted: 02/21/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND The clinical dilemma on the preferred mode of delivery for breech position still exists. Elective caesarean delivery (CD) could be safer for neonates, whereas vaginal breech delivery (VBD) remains a safe option when conducted by an experienced person. Besides successful VBD is beneficial for mothers and subsequent pregnancies. OBJECTIVES To evaluate breech deliveries on mode of delivery, maternal and neonatal outcomes. STUDY DESIGN A single center, retrospective, cohort study was performed of women who delivered a singleton fetus in breech position from 32 weeks' gestation onwards from January 2011 to December 2017. Primary outcome measure was mode of delivery defined as an elective CD and planned VBD. Secondary outcome measures were neonatal and maternal outcome. For neonatal outcome, we used neonatal mortality and a composite measure neonatal morbidity. Maternal outcome included maternal mortality and maternal morbidity divided in severe and non-severe complications. We subcategorized for preterm (32 weeks to 37 weeks of gestation) and term pregnancies (from 37 weeks of gestation onwards). RESULTS 1.774 women delivered a child in breech position, 73 % opted for an elective CD. Of the 484 women that had a planned VBD (preterm 38 % (n = 59), term 26 % (n = 425)) 71 % were successful. Neonatal mortality occurred twice in the VBD cohort. Preterm neonatal morbidity occurred in the elective CD and VBD cohort equally (both 66 %), at term significantly more in the VBD cohort (12 % v 4%, OR 3.2, 95 % CI 2.1-4.8). For the total cohort, severe maternal postpartum complications occurred more often in the elective CD compared to successful VBD (2% v 0.3 %, OR 6.0, 95 % CI 0.80-44.3). CONCLUSION A high rate of successful VBD after opting for a planned VBD was found in our center. Nevertheless, compromised neonatal outcome at term was more frequent in the planned VBD group compared to the elective CD group. Severe maternal postpartum complications were more frequent in the elective CD group compared to the VBD group. Future research should focus alternations in the management of breech presentation.
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Hardy L, Garratt JL, Crossley B, Copson S, Nathan E, Calvert K, Epee-Bekima M. A retrospective cohort study of the impact of In Time obstetric simulation training on management of vaginal breech deliveries. Aust N Z J Obstet Gynaecol 2020; 60:704-708. [PMID: 32067227 DOI: 10.1111/ajo.13132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 01/14/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Following the Term Breech Trial, vaginal breech deliveries are rarely undertaken in Australia. Some women choose to have a breech delivery following counselling, while others will present in labour with an undiagnosed breech. Clinicians need to be skilled in vaginal breech delivery despite this being a rare clinical situation. Simulation training provides a means by which uncommon clinical situations can be practised. AIM This study aims to determine if the introduction of a simulation-based training course is associated with an improvement in the management of vaginal breech delivery and neonatal outcomes. METHODS Cases of term vaginal breech delivery five years prior to introduction of In Time training (2001-2005) and five years after In Time training (2007-2011) were identified in a tertiary obstetric hospital (King Edward Memorial Hospital, Perth). There were 136 women identified in the pre-training (2001-2005, n = 56) and post-training (2007-2011, n = 80) groups. Case note review was undertaken to gather information. RESULTS Apgar scores of <7 at five minutes were higher in the post-training cohort (8.8% vs 0%, P = 0.041). Arterial and venous pH readings were similar between cohorts, with a non-significant trend toward improvement in the post-training cohort. Special care nursery admissions and length of hospital stay were unchanged. The primary accoucheur was more likely to be a consultant (35.0% vs 16.4%) in the post-training cohort. Appropriate manoeuvres were more likely to be used in the post-training cohort (52.5% vs 44.6%). CONCLUSIONS Obstetric In Time simulation training improved seniority of accoucheur and documented appropriate manoeuvres in the management of term vaginal breech delivery.
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Affiliation(s)
- Liesel Hardy
- Obstetrics and Gynaecology, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Jayna-Lee Garratt
- Obstetrics and Gynaecology, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Brendan Crossley
- Obstetrics and Gynaecology, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Sean Copson
- Obstetrics and Gynaecology, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Elizabeth Nathan
- Division of Obstetrics and Gynaecology, University of Western Australia, Perth, Western Australia, Australia
| | - Katrina Calvert
- Obstetrics and Gynaecology, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Mathias Epee-Bekima
- Obstetrics and Gynaecology, King Edward Memorial Hospital, Perth, Western Australia, Australia
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Jennewein L, Allert R, Möllmann CJ, Paul B, Kielland-Kaisen U, Raimann FJ, Brüggmann D, Louwen F. The influence of the fetal leg position on the outcome in vaginally intended deliveries out of breech presentation at term - A FRABAT prospective cohort study. PLoS One 2019; 14:e0225546. [PMID: 31790449 PMCID: PMC6886779 DOI: 10.1371/journal.pone.0225546] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 11/06/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Vaginal delivery out of a breech presentation in pregnancies at term are being re-implemented into clinical practice. Still, recommendations regarding exclusion criteria leading to caesarean sections are based on expert opinions, not on evidence-based guidelines. The difference in perinatal outcome and course of delivery in births with babies in frank breech position and babies in incomplete or complete breech presentation never has been investigated in a large patient cohort. OBJECTIVE To compare perinatal outcome of vaginally intended breech deliveries between births out of frank breech position and incomplete/complete breech presentation. DESIGN Prospective cohort study. SAMPLE 884 women at term with a singleton in frank breech presentation (FB) and 284 women with incomplete or complete breech presentation (CB) intending vaginal birth between January 2004 and December 2018. METHODS Maternal and fetal outcome was compared between groups using Pearson's Chi Square test. Birth duration parameters were analysed using logistic regression. RESULTS There were no differences in cesarean section rates (FB: 25.1%, CB 22.2%, p = 0.317). Short-term fetal morbidity did not differ between groups (FB: 2.5%, CB: 2.8%, p = 0.761). In vaginal deliveries the necessity to perform manual assistance was significantly more frequent in deliveries of infants in CB (FB: 39.9%, CB: 51.6%, p = 0.0013). Cord loops (FB: 10.1%, CB: 18.0%, p = 0.0004) and cesarean sections necessary because of cord prolapses (FB: 1.4%, CB 8.1%, p = 0.005) were significantly more often in deliveries with babies in CB. CONCLUSION This study provides evidence, that perinatal morbidity is not associated with the fetal leg posture in vaginally intended breech deliveries. The higher risk for the need of manual assistance during vaginal birth in deliveries of babies out of complete or incomplete breech presentation suggests that obstetrical departments re-implementing the vaginal breech in their repertoire might start with births of babies out of frank breech presentation.
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Affiliation(s)
- Lukas Jennewein
- FRABAT FRAnkfurt Breech At Term Study Group; Department of Gynecology and Obstetrics, School of Medicine, Goethe-University, Theodor-Stern-Kai 7, Frankfurt, Germany
| | - Roman Allert
- FRABAT FRAnkfurt Breech At Term Study Group; Department of Gynecology and Obstetrics, School of Medicine, Goethe-University, Theodor-Stern-Kai 7, Frankfurt, Germany
| | - Charlotte J. Möllmann
- FRABAT FRAnkfurt Breech At Term Study Group; Department of Gynecology and Obstetrics, School of Medicine, Goethe-University, Theodor-Stern-Kai 7, Frankfurt, Germany
| | - Bettina Paul
- FRABAT FRAnkfurt Breech At Term Study Group; Department of Gynecology and Obstetrics, School of Medicine, Goethe-University, Theodor-Stern-Kai 7, Frankfurt, Germany
| | - Ulrikke Kielland-Kaisen
- FRABAT FRAnkfurt Breech At Term Study Group; Department of Gynecology and Obstetrics, School of Medicine, Goethe-University, Theodor-Stern-Kai 7, Frankfurt, Germany
| | - Florian J. Raimann
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Dörthe Brüggmann
- FRABAT FRAnkfurt Breech At Term Study Group; Department of Gynecology and Obstetrics, School of Medicine, Goethe-University, Theodor-Stern-Kai 7, Frankfurt, Germany
| | - Frank Louwen
- FRABAT FRAnkfurt Breech At Term Study Group; Department of Gynecology and Obstetrics, School of Medicine, Goethe-University, Theodor-Stern-Kai 7, Frankfurt, Germany
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Hipsher C, Fineberg A. Up against a wall: A patient and obstetrician's perspective on the mode of breech delivery. Birth 2019; 46:543-546. [PMID: 31119789 DOI: 10.1111/birt.12432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 04/08/2019] [Accepted: 04/09/2019] [Indexed: 01/14/2023]
Affiliation(s)
| | - Annette Fineberg
- Department of Women's Health, Sutter Medical Group, Davis, California
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[Breech Presentation: CNGOF Guidelines for Clinical Practice - Benefits and Risks for the Neonate and Child of Planned Vaginal Delivery versus Elective Cesarean Section]. ACTA ACUST UNITED AC 2019; 48:95-108. [PMID: 31678508 DOI: 10.1016/j.gofs.2019.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To provide guidelines regarding the benefits and risks for the neonate and the child of planning vaginal delivery versus planning elective cesarean section in case of term breech presentation. METHODS MedLine and Cochrane Library databases search and review of the main foreign guidelines. RESULTS In case of term breech presentation, planned vaginal delivery might be associated with an increased composite risk of perinatal mortality or occurrence of a combined outcome of serious neonatal morbidity in comparison to elective cesarean section (LE2). In case of planned vaginal delivery of term breech presentation, the risk of perinatal mortality is around 1‰ (LE3). It is potentially less but still exists in case of elective cesarean section (LE2). Risks of neonatal trauma - especially fracture of clavicle and breech hematoma -, Apgar score lower than 7 at 5minutes, and need for neonatal intubation and ventilation, are increased in case of planned vaginal delivery (LE2) and are around 1% (LE3). However, no difference has been demonstrated between planned vaginal and planned cesarean delivery regarding neurodevelopmental outcomes at 2 years (LE2), cognitive and psychomotor outcomes between 5 and 8 years (LE3), and adult intellectual performances (LE4). CONCLUSIONS In case of term breech presentation, risks of severe complications for neonate and child are low in case of planned vaginal delivery or elective cesarean section. Short-term benefit/risk balance for the neonate might favor elective cesarean section but long-term morbidity seems to be similar whatever the delivery route (Professional consensus).
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What if something goes wrong? A grounded theory study of parents’ decision-making processes around mode of breech birth at term gestation. Midwifery 2019; 78:114-122. [DOI: 10.1016/j.midw.2019.08.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 07/03/2019] [Accepted: 08/08/2019] [Indexed: 11/20/2022]
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Azria É. [Breech Presentation: CNGOF Guidelines for Clinical Practice - Case Selection for Trial of Labour]. ACTA ACUST UNITED AC 2019; 48:120-131. [PMID: 31678509 DOI: 10.1016/j.gofs.2019.10.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The objective of this chapter is to examine on the basis of the knowledge currently available the criteria available before labour for selecting women who would be eligible for trial of vaginal delivery. METHODOLOGY Bibliographical research in French and English using the Medline and Cochrane databases between 1980 and 2019 and the recommendations of international societies. RESULTS It is recommended to offer women who wish to attempt a vaginal delivery at term a pelvimetry to decide with them on their mode of delivery (Grade C). The pelvimetric standards used at the time of the PREMODA study were anteroposterior diameter of inlet≥105mm, a transverse diameter of inlet≥120mm, a transverse interspinous diameter≥100mm. However, since there is no evidence about which pelvic measures to use, nor any evidence to set decision-making thresholds other than those set in published studies, the selected decision-making thresholds can be adjusted according to gestational age at delivery or fetal biometrics (Professional consensus). There is no argument for recommending the practice of pelvimetry in the case of delivery before 37 weeks gestational age (Professional consensus) and in the case of breech presentation discovered at the time of beginning of labour, the absence of pelvimetry alone does not contraindicate the attempt of vaginal delivery (Professional consensus). There is insufficient data to recommend the systematic use of fetal weight estimation and/or biparietal diameter measurement as acceptance criteria for a vaginal delivery attempt. In the event of a known fetal weight estimation before birth greater than 3800g, a cesarean section is to be preferred (Professional consensus). The breech presentation is not in itself a contraindication to an attempt of vaginal delivery for a small fetus for gestational age (Professional consensus). The presentation of the non-frank breech is not in itself a contraindication to an attempt of vaginal delivery (Professional consensus). In the case of premature breech delivery, current data do not allow to recommend one delivery route over another (Professional consensus). It is recommended to check the absence of hyperextension of the fetal head by ultrasound before an attempt of vaginal delivery (Professional consensus) and to prefer a cesarean section if such a position is found (Professional consensus). It is not recommended to propose a caesarean section with the sole reason of nulliparity (Grade C). The history of cesarean section is not in itself a contraindication to an attempt of vaginal delivery in the case of fetal breech presentation (Professional consensus). Premature rupture of the membranes is not in itself a contraindication to an attempt of vaginal delivery (Professional consensus). CONCLUSION A number of the factors analyzed in this chapter are to be incorporated into the decision-making process in order to choose with the woman whose fetus is in breech presentation the delivery route.
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Affiliation(s)
- É Azria
- Maternité Notre-Dame-de-Bon-Secours, groupe hospitalier Paris Saint-Joseph, DHU risques et grossesse, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France; Inserm UMR 1153, équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), centre de recherche épidémiologie et statistique Sorbonne Paris Cité, 75000 Paris, France; Université de Paris, 75000 Paris, France.
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Bjellmo S, Hjelle S, Krebs L, Magnussen E, Vik T. Adherence to guidelines and suboptimal practice in term breech delivery with perinatal death- a population-based case-control study in Norway. BMC Pregnancy Childbirth 2019; 19:330. [PMID: 31500581 PMCID: PMC6734432 DOI: 10.1186/s12884-019-2464-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 08/20/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In a recent population-based study we reported excess risk of neonatal mortality associated with vaginal breech delivery. In this case-control study we examine whether deviations from Norwegian guidelines are more common in breech deliveries resulting in intrapartum or neonatal deaths than in breech deliveries where the offspring survives, and if these deaths are potentially avoidable. MATERIAL AND METHODS Case-control study completed as a perinatal audit including term breech deliveries of singleton without congenital anomalies in Norway from 1999 to 2015. Deliveries where the child died intrapartum or in the neonatal period were case deliveries. For each case, two control deliveries who survived were identified. All the included deliveries were reviewed by four obstetricians independently assessing if the deaths in the case group might have been avoided and if the management of the deviations from Norwegian guidelines were more common in case than in control deliveries. RESULTS Thirty-one case and 62 control deliveries were identified by the Medical Birth Registry of Norway. After exclusion of non-eligible deliveries, 22 case and 31 control deliveries were studied. Three case and two control deliveries were unplanned home deliveries, while all in-hospital deliveries were in line with national guidelines. Antenatal care and/or management of in-hospital deliveries was assessed as suboptimal in seven (37%) case and two (7%) control deliveries (p = 0.020). Three case deliveries were completed as planned caesarean delivery and 12 (75%) of the remaining 16 deaths were considered potentially avoidable had planned caesarean delivery been done. In seven of these 16 deliveries, death was associated with cord prolapse or difficult delivery of the head. CONCLUSION All in-hospital breech deliveries were in line with Norwegian guidelines. Seven of twelve potentially avoidable deaths were associated with birth complications related to breech presentation. However, suboptimal care was more common in case than control deliveries. Further improvement of intrapartum care may be obtained through continuous rigorous training and feedback from repeated perinatal audits.
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Affiliation(s)
- Solveig Bjellmo
- Department of Obstetrics and Gynecology, More and Romsdal Hospital Trust, Postbox 1600, 6026, Aalesund, Norway.
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Sissel Hjelle
- Department of Obstetrics and Gynecology, More and Romsdal Hospital Trust, Postbox 1600, 6026, Aalesund, Norway
| | - Lone Krebs
- Department of Gynecology and Obstetrics, University of Copenhagen Holbaek Hospital, Holbaek, Denmark
| | - Elisabeth Magnussen
- Department of Obstetrics and Gynecology, St Olav's University Hospital, Trondheim, Norway
| | - Torstein Vik
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Carlin A, Kadji C, Cannie MM, Resta S, Kang X, Jani JC. The use of magnetic resonance imaging in the prediction of birthweight. Prenat Diagn 2019; 40:125-135. [PMID: 31319434 DOI: 10.1002/pd.5530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/05/2019] [Accepted: 07/08/2019] [Indexed: 01/11/2023]
Abstract
Extremes of fetal growth can increase adverse pregnancy outcomes, and this is equally applicable to single and multiple gestations. Traditionally, these cases have been identified using simple two-dimensional ultrasound which is quite limited by its low precision. Magnetic resonance imaging (MRI) has now been used for many years in obstetrics, mainly as an adjunct to ultrasound for congenital abnormalities and increasingly as part of the post-mortem examination. However, MRI can also be used to accurately assess fetal weight as first demonstrated by Baker et al in 1994, using body volumes rather than standard biometric measurements. This publication was followed by several others, all of which confirmed the superiority of MRI; however, despite this initial promise, the technique has never been successfully integrated into clinical practice. In this review, we provide an overview of the literature, detail the various techniques and formulas currently available, discuss the applicability to specific high-risk groups and present our vision for the future of MRI within clinical obstetrics.
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Affiliation(s)
- Andrew Carlin
- Department of Obstetrics and Gynaecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Caroline Kadji
- Department of Obstetrics and Gynaecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Mieke M Cannie
- Department of Radiology, University Hospital Brugmann, Brussels, Belgium.,Department of Radiology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Serena Resta
- Department of Obstetrics and Gynaecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Xin Kang
- Department of Obstetrics and Gynaecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Jacques C Jani
- Department of Obstetrics and Gynaecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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No. 384-Management of Breech Presentation at Term. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1193-1205. [DOI: 10.1016/j.jogc.2018.12.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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No 384 - Prise en charge de la présentation du siège du fœtus à terme. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1206-1220. [DOI: 10.1016/j.jogc.2019.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Gaillard T, Girault A, Alexander S, Goffinet F, Le Ray C. Is induction of labor a reasonable option for breech presentation? Acta Obstet Gynecol Scand 2019; 98:885-893. [PMID: 30723903 DOI: 10.1111/aogs.13557] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/29/2019] [Accepted: 01/30/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Whereas spontaneous onset of labor and vaginal delivery for breech presentation is considered to be a safe and effective option in selected cases, the safety of induction of labor is not established yet. The objectives of this study were to describe the outcomes of pregnancy in women induced with a fetus in breech presentation and compare the outcomes with those undergoing planned cesarean delivery. MATERIAL AND METHODS We performed a secondary analysis of the observational prospective multicenter PREMODA study, including all singleton breech deliveries after 37 weeks in 174 centers in France and Belgium. We excluded women with spontaneous onset of labor, scarred uterus or intrauterine fetal death. Our study population consisted of women with either induction of labor or planned cesarean delivery. The primary outcome was the composite criteria of neonatal mortality and serious morbidity used in the Term Breech Trial and in the PREMODA prospective cohort. RESULTS Our study population consisted of 4138 women, 218 with induction of labor and 3920 with planned cesarean. Two-thirds (67.4%) of the women in the induction of labor group delivered vaginally. There was no significant difference between the groups for the primary outcome (48 [1.2%] in the planned cesarean group vs 3 [1.4%] in the induction of labor group, P = 0.75). Moreover, none of the criteria of the composite primary outcome was significantly more frequent in the induction of labor group. CONCLUSIONS Induction of labor for breech presentation does not seem to increase neonatal mortality or severe neonatal morbidity compared with planned cesarean delivery.
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Affiliation(s)
- Thomas Gaillard
- Port Royal Maternity Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,DHU Risks in Pregnancy, Paris, France.,Sorbonne Medical Faculty, Paris Descartes University, Paris, France
| | - Aude Girault
- Port Royal Maternity Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,DHU Risks in Pregnancy, Paris, France.,Sorbonne Medical Faculty, Paris Descartes University, Paris, France.,INSERM, UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center of Research in Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris, France
| | - Sophie Alexander
- Perinatal Epidemiology and Reproductive Health Unit, Epidemiology, Biostatistics and Clinical Research Center, Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
| | - François Goffinet
- Port Royal Maternity Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,DHU Risks in Pregnancy, Paris, France.,Sorbonne Medical Faculty, Paris Descartes University, Paris, France.,INSERM, UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center of Research in Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris, France
| | - Camille Le Ray
- Port Royal Maternity Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,DHU Risks in Pregnancy, Paris, France.,Sorbonne Medical Faculty, Paris Descartes University, Paris, France.,INSERM, UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center of Research in Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris, France
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39
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Yeoh SGJ, Rolnik DL, Regan JA, Lee PYA. Experience and confidence in vaginal breech and twin deliveries among obstetric trainees and new specialists in Australia and New Zealand. Aust N Z J Obstet Gynaecol 2018; 59:545-549. [DOI: 10.1111/ajo.12931] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 11/14/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Sara G. J. Yeoh
- Department of Obstetrics and Gynaecology; Monash Health; Melbourne Victoria Australia
| | - Daniel L. Rolnik
- Department of Obstetrics and Gynaecology; Monash Health; Melbourne Victoria Australia
| | - John A. Regan
- Department of Obstetrics and Gynaecology; Monash Health; Melbourne Victoria Australia
| | - Peter Y. A. Lee
- Department of Obstetrics and Gynaecology; Eastern Health; Melbourne Victoria Australia
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Fischbein SJ, Freeze R. Breech birth at home: outcomes of 60 breech and 109 cephalic planned home and birth center births. BMC Pregnancy Childbirth 2018; 18:397. [PMID: 30305050 PMCID: PMC6180643 DOI: 10.1186/s12884-018-2033-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 09/27/2018] [Indexed: 01/17/2023] Open
Abstract
Background Research on outcomes of out-of-hospital breech birth is scarce. This study evaluates the outcomes of singleton term breech and cephalic births in a home or birth center setting. Methods This is a retrospective observational cohort study of 60 breech and 109 cephalic planned out-of-hospital term singleton births during a 6 year period with a single obstetrician. Outcomes measured included mode of delivery; birth weights; 1 & 5-min Apgar scores; ante-, intra-, and post-partum transports; perineal integrity; and other maternal and neonatal morbidity. Results 50 breech and 102 cephalic presentations were still in the obstetrician’s care at the onset of labor; of those, 10 breech and 11 cephalic mothers required transport during labor. 76% of breech and 92.2% of cephalic births were planned to occur at home, with the remainder at a freestanding birth center. When compared to the cephalic group, the breech group had a higher rate of antepartum and in-labor transfer of care and cesarean section. Among completed out-of-hospital births, the breech group had a significantly higher rate of 1-min Apgar scores < 7 but no significant difference at 5 min. Rates of vaginal birth for both groups were high, with 84% of breech and 97.1% of cephalic mothers giving birth vaginally in this series. Compared to primiparas, multiparas in both groups had less perineal trauma and higher rates of out-of-hospital birth, vaginal birth, and spontaneous vaginal birth. No breech infant or mother required postpartum hospital transport, while one cephalic infant and one cephalic mother required postpartum transport. Of the babies born out-of-hospital, there was one short-term and one longer-term birth injury among the breech group and one short-term brachial plexus injury in the cephalic group. Conclusions A home or birth center setting leads to high rates of vaginal birth and good maternal outcomes for both breech and cephalic term singleton presentations. Out-of-hospital vaginal breech birth under specific protocol guidelines and with a skilled provider may be a reasonable choice for women wishing to avoid a cesarean section—especially when there is no option of a hospital breech birth. However, this study is underpowered to calculate uncommon adverse neonatal outcomes.
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Affiliation(s)
| | - Rixa Freeze
- Wabash College, 211 Center Hall, Crawfordsville, IN, 47933, USA.
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41
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Walker S, Parker P, Scamell M. Expertise in physiological breech birth: A mixed-methods study. Birth 2018; 45:202-209. [PMID: 29205469 DOI: 10.1111/birt.12326] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 10/21/2017] [Accepted: 10/21/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The safety of vaginal breech birth depends on the expertise of birth attendants, yet the meaning of "expertise" remains unclear and subjectively defined. The objective of this study was to define expertise and the roles experts may play in expanding access to this service. METHODS We performed an integrative analysis of two strands of data concerning expertise in physiological breech birth, including the following: survey data from a Delphi study involving 26 very experienced clinicians (mean experience = 135 breech births) and 2 service user representatives, and interviews from a grounded theory study of 14 clinicians more moderately experienced with physiological methods (5-30 upright breech births). Data were pooled and analyzed using constant comparative methods. RESULTS Expertise is defined by its ongoing function, the generation of comparatively good outcomes, and confidence and competence among colleagues. Although clinical experience is important, expertise is developed and expressed in social clinical roles, which expand as experience grows: clinician, mentor, specialist, and expert. To develop expertise within a service, clinicians who have an interest in breech birth should be supported to perform these roles within specialist teams. CONCLUSIONS Specialist breech teams may facilitate the development of expertise within maternity care settings. Evaluation of expertise based on enablement of women and colleagues, as well as outcomes, will potentially avoid the pitfalls of alienation produced by some forms of specialist authority.
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Affiliation(s)
- Shawn Walker
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - Pam Parker
- Department for Learning Enhancement and Development, City, University of London, Northampton Square, London, UK
| | - Mandie Scamell
- Centre for Maternal and Child Health Research, City, University of London, Northampton Square, London, UK
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42
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Delivery of the second twin: influence of presentation on neonatal outcome, a case controlled study. BMC Pregnancy Childbirth 2018; 18:176. [PMID: 29776396 PMCID: PMC5960113 DOI: 10.1186/s12884-018-1815-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 05/01/2018] [Indexed: 12/15/2022] Open
Abstract
Background Spontaneous vaginal twin delivery after 32nd week of gestation is safe when first twin presenting cephalic. Aim of this study is to identify obstetric factors influencing the condition of second twin and to verify whether non-cephalic presentation and vaginal breech delivery of the second twin is safe. Methods This is a retrospective case controlled cohort study of 717 uncomplicated twin deliveries ≥32 + 0 weeks of gestation from 2005 to 2014 in two tertiary perinatal centers. Obstetric parameters were evaluated in three groups with descriptive, univariate logistic regression analysis for perinatal outcome of second twins. Results The three groups included twins delivered by elective cesarean section ECS (n = 277, 38.6%), by unplanned cesarean section UPC (n = 233, 32.5%) and vaginally (n = 207, 28.9%). Serious adverse fetal outcome is rare and we found no differences between the groups. Second twins after ECS had significant better umbilical artery UA pH (p < 0.001) and better Apgar compared to UPC (p = 0.002). Variables for a fetal population “at risk” for adverse neonatal outcome after vaginal delivery (UA pH < 7.20, Apgar 5´ < 9) were associated with higher gestational age (p = 0.001), longer twin-twin interval (p = 0.05) and vacuum extraction of twin A (p = 0.04). Non-cephalic presentation of second twins was not associated (UA pH < 7.20 OR 1.97, CI 95% 0.93–4.22, p = 0.07, Apgar 5´ < 9 OR 1.63, CI 95% 0.70–3.77, p = 0.25, Transfer to neonatal intermediate care unit p = 0.48). Twenty-one second twins (2,9%) were delivered by cesarean section following vaginal delivery of the first twin. Even though non-cephalic presentation was overrepresented in this subgroup, outcome variables were not significantly different compared to cephalic presentation. Conclusions Even though elective cesarean means reduced stress for second twins this seems not to be clinically relevant. Non-cephalic presentation of the second twin does not significantly influence the perinatal outcome of the second twin but might be a risk factor for vaginal-cesarean birth.
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Montoya-Williams D, Lemas DJ, Spiryda L, Patel K, Neu J, Carson TL. What Are Optimal Cesarean Section Rates in the U.S. and How Do We Get There? A Review of Evidence-Based Recommendations and Interventions. J Womens Health (Larchmt) 2017; 26:1285-1291. [PMID: 28825512 DOI: 10.1089/jwh.2016.6188] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Cesarean sections (CSs) are the most commonly performed surgical procedures in the world today. Global epidemiological studies from the last decade suggest that the optimal CS rates in developed countries exist somewhere between 15% and 19%. Despite these findings, CS rates in the United States have remained stable at slightly over 32% over the past 10 years. Using primary and secondary literature published from 2010 to 2015, this review discusses how optimal CS rates were developed. In addition, we define a category of potentially avoidable CS (i.e., those conducted on nulliparous low-risk women who present with vertex infants at term) and explore how CS in this population appear to be one of the main drivers of high CS rates overall. The institutional, provider, and patient-related factors, which may be related to higher-than-recommended rates of CS, particularly those conducted in low-risk women, will be discussed. This review will then delve into clinician and patient-oriented interventions that have been shown to effectively reduce the rate of potentially avoidable CS. Our analysis showed that large-scale, multifaceted interventions that include audit and feedback cycles as well as peer review strategies were the most effective in decreasing rates of potentially avoidable CS. This review concludes with an agenda for future research into interventions that aim to achieve optimal CS rates.
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Affiliation(s)
- Diana Montoya-Williams
- 1 Division of Neonatology, Department of Pediatrics, University of Florida , Gainesville, Florida
| | - Dominick J Lemas
- 2 Department of Health Outcomes and Policy, University of Florida , Gainesville, Florida
| | - Lisa Spiryda
- 3 Department of Obstetrics and Gynecology, University of Florida , Gainesville, Florida
| | - Keval Patel
- 4 Department of Biology, College of Liberal Arts and Sciences, University of Florida, Gainesville, Florida
| | - Josef Neu
- 1 Division of Neonatology, Department of Pediatrics, University of Florida , Gainesville, Florida
| | - Tiffany L Carson
- 5 Division of Preventive Medicine, Department of Medicine, University of Alabama , Birmingham, Alabama
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44
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Petrovska K, Sheehan A, Homer CSE. Media Representations of Breech Birth: A Prospective Analysis of Web-Based News Reports. J Midwifery Womens Health 2017; 62:434-441. [PMID: 28703897 DOI: 10.1111/jmwh.12609] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 01/08/2017] [Accepted: 01/13/2017] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Recent research has demonstrated that the media presentation of childbirth is highly medicalized, often portraying birth as risky and dramatic. Media representation of breech presentation and birth is unexplored in this context. This study aimed to explore the content and tone of news media reports relating to breech presentation and breech birth. METHODS Google alerts were created using the terms breech and breech birth in online English-language news sites over a 3-year period from January 1, 2013, to December 31, 2015. Alerts were received daily and filed for analysis, and data were analyzed to generate themes. RESULTS A total of 138 web-based news reports were gathered from 9 countries. Five themes that arose from the data included the problem of breech presentation, the high drama of vaginal breech birth, the safe option of cesarean birth versus dangers of vaginal breech birth, the defiant mother versus the saintly mother, and vaginal breech birth and medical misadventure. DISCUSSION Media reports in this study predominantly demonstrated negative views toward breech presentation and vaginal breech birth. Cesarean birth was portrayed as the safe option for breech birth, while vaginal breech birth was associated with poor outcomes. Media presentations may impact decision making about mode of birth for pregnant women with a breech fetus. Health care providers can play an important role in balancing the media depiction of planned vaginal breech birth by providing nonjudgmental, evidence-based information to such women to facilitate informed decision making for birth.
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45
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Seeho SK, Nippita TA. Term breech delivery: Is recommending vaginal birth a breach of best practice? Aust N Z J Obstet Gynaecol 2017; 57:375-377. [DOI: 10.1111/ajo.12644] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Accepted: 04/17/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Sean K.M. Seeho
- Clinical and Population Perinatal Health Research; Kolling Institute; Sydney New South Wales Australia
- Sydney Medical School - Northern, University of Sydney; Sydney New South Wales Australia
- Department of Obstetrics and Gynaecology; Royal North Shore Hospital; Sydney New South Wales Australia
| | - Tanya A. Nippita
- Clinical and Population Perinatal Health Research; Kolling Institute; Sydney New South Wales Australia
- Sydney Medical School - Northern, University of Sydney; Sydney New South Wales Australia
- Department of Obstetrics and Gynaecology; Royal North Shore Hospital; Sydney New South Wales Australia
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Bisits A. There is a place in current obstetric practice for planned vaginal breech birth. Aust N Z J Obstet Gynaecol 2017; 57:372-374. [DOI: 10.1111/ajo.12643] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 04/17/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Andrew Bisits
- Department of Maternity; Royal Hospital for Women; Sydney New South Wales Australia
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47
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Bjellmo S, Andersen GL, Martinussen MP, Romundstad PR, Hjelle S, Moster D, Vik T. Is vaginal breech delivery associated with higher risk for perinatal death and cerebral palsy compared with vaginal cephalic birth? Registry-based cohort study in Norway. BMJ Open 2017; 7:e014979. [PMID: 28473516 PMCID: PMC5566597 DOI: 10.1136/bmjopen-2016-014979] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE This paper aims to study if vaginal breech delivery is associated with increased risk for neonatal mortality (NNM) or cerebral palsy (CP) in Norway where vaginal delivery accounts for 1/3 of all breech deliveries. DESIGN Cohort study using information from the national Medical BirthRegister and Cerebral Palsy Register. SETTING Births in Norway 1999-2009. PARTICIPANTS 520 047 term-born singletons without congenital malformations. MAIN OUTCOME MEASURES NNM, CP and a composite outcome of these and death during birth. RESULTS Compared with cephalic births, breech births had substantially increased risk for NNM but not for CP. Vaginal delivery was planned for 7917 of 16 700 fetuses in breech, while 5561 actually delivered vaginally. Among these, NNM was 0.9 per 1000 compared with 0.3 per 1000 in vaginal cephalic delivery, and 0.8 per 1000 in those actually born by caesarean delivery (CD) in breech. Compared with planned cephalic delivery, planned vaginal delivery was associated with excess risk for NNM (OR 2.4; 95% CI 1.2 to 4.9), while the OR associated with planned breech CD was 1.6 (95% CI 0.7 to 3.7). These risks were attenuated when NNM was substituted by the composite outcome. Vaginal breech delivery was not associated with excess risk for CP compared with vaginal cephalic delivery. CONCLUSION Vaginal breech delivery, regardless of whether planned or actual, and actual breech CD were associated with excess risk for NNM compared with vaginal cephalic delivery, but not with CP. The risk for NNM and CP in planned breech CD did not differ significantly from planned vaginal cephalic delivery. However, the absolute risk for these outcomes was low, and taking into consideration potential long-term adverse consequences of CD for the child and later deliveries, we therefore conclude that vaginal breech delivery may be recommended, provided competent obstetric care and strict criteria for selection to vaginal delivery.
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Affiliation(s)
- Solveig Bjellmo
- Department of Obstetrics and Gynecology, Helse More og Romsdal HF, Alesund, Norway
- The Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Guro L Andersen
- The Norwegian University of Science and Technology, NTNU, Trondheim, Norway
- The Cerebral Palsy Registry of Norway, Habilitation Center, Vestfold Hospital, Tønsberg, Norway
| | - Marit Petra Martinussen
- The Norwegian University of Science and Technology, NTNU, Trondheim, Norway
- Department of Laboratory Medicine, Children’s and Women’s Health, LBK, Trondheim, Norway
- Department of Obstetrics and Gynecology, St Olav`s Hospital, Trondheim, Norway
| | - Pål Richard Romundstad
- The Norwegian University of Science and Technology, NTNU, Trondheim, Norway
- Department of Public Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sissel Hjelle
- Department of Obstetrics and Gynecology, Helse More og Romsdal HF, Alesund, Norway
| | - Dag Moster
- Institute of Global Public Health and Primary Care, UiB, Bergen, Norway
- Department of Paediatrics, Hauekland University Hospital, Bergen, Norway
| | - Torstein Vik
- The Norwegian University of Science and Technology, NTNU, Trondheim, Norway
- Department of Laboratory Medicine, Children’s and Women’s Health, LBK, Trondheim, Norway
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Lorthe E, Quere M, Sentilhes L, Delorme P, Kayem G. Incidence and risk factors of caesarean section in preterm breech births: A population-based cohort study. Eur J Obstet Gynecol Reprod Biol 2017; 212:37-43. [DOI: 10.1016/j.ejogrb.2017.03.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 03/08/2017] [Indexed: 11/26/2022]
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49
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Petrovska K, Sheehan A, Homer CS. The fact and the fiction: A prospective study of internet forum discussions on vaginal breech birth. Women Birth 2017; 30:e96-e102. [DOI: 10.1016/j.wombi.2016.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 09/13/2016] [Accepted: 09/29/2016] [Indexed: 10/20/2022]
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50
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Burgos J, Arana I, Garitano I, Rodríguez L, Cobos P, Osuna C, Del Mar Centeno M, Fernández-Llebrez L. Induction of labor in breech presentation at term: a retrospective cohort study. J Perinat Med 2017; 45:299-303. [PMID: 27105484 DOI: 10.1515/jpm-2015-0426] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 03/21/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare the outcome of two methods of labor induction and spontaneous onset of labor in breech presentation at term. MATERIAL A retrospective study between 2003 and 2012. We compare obstetric (indication of induction, Bishop score, cesarean rate) and perinatal outcomes (Apgar score, umbilical artery pH, base excess ≤-12 mmol/L, admission to neonatal unit) between prostaglandins and oxytocin. We also compare labor induction versus spontaneous onset of labor. RESULTS Of the 1684 breech deliveries, we carried out labor induction in 221 cases (76% with prostaglandins, 24% with oxytocin). The prostaglandins group had significantly lower Bishop scores and the time for induction phase was significantly higher. There were no differences in cesarean rate between both methods of induction or spontaneous onset of labor. The prostaglandins group had higher rates of base excess ≤-12 mmol/L. Compared with spontaneous onset of labor in breech presentation, induction had significant lower rates of newborn weight and higher rates of admission to the neonatal unit. CONCLUSIONS Induction of labor in breech presentation at term is a reasonable and effective option after a careful selection of cases. It was not associated with an increase of perinatal morbidity or cesarean rate compared with spontaneous onset of labor.
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Affiliation(s)
- Jorge Burgos
- Obstetrics and Gynecology Service, BioCruces Health Research Institute, Hospital Universitario Cruces, C/Plaza de Cruces 12, 48903, Baracaldo, Biscay
| | - Itziar Arana
- University of the Basque Country (UPV/EHU), Biscay
| | | | | | | | - Carmen Osuna
- University of the Basque Country (UPV/EHU), Biscay
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