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Breech presentation induction compared to cephalic presentation: Effectiveness and characteristics. Eur J Obstet Gynecol Reprod Biol 2023; 282:155-160. [PMID: 36738640 DOI: 10.1016/j.ejogrb.2023.01.030] [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: 09/16/2022] [Revised: 01/17/2023] [Accepted: 01/24/2023] [Indexed: 01/27/2023]
Abstract
INTRODUCTION The objective of our study was to compare the effectiveness of induction in cephalic presentations to that of breech presentations as well as the characteristics of the latter and the maternal-fetal morbidity and mortality. MATERIAL AND METHODS This was a single-center retrospective study carried out at the Lille University Hospital in the Jeanne de Flandre Maternity Hospital including all patients with a breech fetus for whom an induction was indicated beyond 37 weeks of gestation between January 2014 and December 2020. A matching was performed to include 2 cephalic presentations for one breech presentation. The primary outcome was successful induction defined by two things: passage into the active phase (cervical dilatation > 5 cm) and vaginal delivery. RESULTS 101 inductions of breech presentations were included and matched to 202 cephalic presentations. After adjustment by BISHOP score, there was no significant difference in the caesarean section rate between the two groups (25.7% in cephalic vs 33.7% in breech, OR 0.67 [CI95% 0.38-1.18]) or in the rate of transition to active phase (80.7% in cephalic vs 82.2% in breech, OR 1.26 [CI95% 0.65-2.44]). Post-partum blood loss was not significantly different between the two groups (14.4% in cephalic vs 12.9% in breech, OR 1.22 [CI95% 0.57-2.57]). Moderate neonatal acidosis was more frequent in the breech group (6,4% in cephalic vs 15,8% in breech, OR 3.04 [CI95% 1.38-6.71]). CONCLUSION Induction of breech births beyond 37 weeks of gestation appeared to be as effective as induction of cephalic presentations. There was no difference in the rate of caesarean section and transition to active labor. Maternal morbidity was not increased.
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Fard D, Borchers CS, Philippeit JC, Philippeit AV, Kaukemüller LR, Higgins-Wood LR, Papageorgiou S, Hillemanns P, von Kaisenberg CS, Klapdor R. Comparing forces on the fetal neck in breech delivery in lithotomy versus all-fours position: a simulation model. Arch Gynecol Obstet 2022; 308:91-99. [PMID: 35857095 DOI: 10.1007/s00404-022-06671-5] [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: 04/13/2022] [Accepted: 06/14/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To measure forces applied to the fetal neck, in a simulation model for breech delivery, in both lithotomy versus all-fours position. METHODS We used a Laerdal SimMom simulator and a Birthing Baby together with PROMPT Flex Software. The descent of the fetus was accomplished using the Automatic Delivery Module 2. The baby was always in breech position; the SimMom in either all-fours or lithotomy positions. Sensors were located inside the fetal neck region to simulate forces applied to the plexus. RESULTS The lowest force on the fetal neck region was recorded for the delivery in all-fours position without further maneuvers (mean force 58.70 Newton, standard deviation 2.54 N). As weight was added to the baby, the force increased (i.e. + 500 g, mean force 71.8 N, SD 3.08 N, p < 0.001). Delivery in lithotomy position resulted in a mean force of 81.56 N (SD 19.55 N). The force significantly increased in case of delivery of the head without assistance from contractions (mean force 127.93 N, SD 23.10 N). In all-fours position, the delivery of the fetal head from pelvic floor level without contractions (Frank's Nudge maneuver) resulted in a mean force of 118.45 N (SD 15.48 N, p = 0.02). Maneuvers for shoulder dystocia (the inverted type that can occur during breech delivery) led to significantly higher mean forces independent from birthing positions. CONCLUSION Breech delivery in all-fours position was associated with the lowest force acting on the fetal neck in our simulation model.
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Affiliation(s)
- Delnaz Fard
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - Chiara S Borchers
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - Jill-Caren Philippeit
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - Anja V Philippeit
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - Laura R Kaukemüller
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - Lara R Higgins-Wood
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - Spyridon Papageorgiou
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - Peter Hillemanns
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - Constantin S von Kaisenberg
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - Rüdiger Klapdor
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany.
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Khobzaoui M, Ghesquiere L, Drumez E, Debarge V, Subtil D, Garabedian C. Cervical maturation in breech presentation: Mechanical versus prostaglandin methods. J Gynecol Obstet Hum Reprod 2022; 51:102404. [DOI: 10.1016/j.jogoh.2022.102404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/28/2022] [Accepted: 05/04/2022] [Indexed: 11/16/2022]
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Ghesquière L, Rouilles J, Drumez E, Houfflin-Debarge V, Subtil D, Garabedian C. Is it reasonable to propose vaginal delivery with twin pregnancies, when the first twin is in breech presentation? J Gynecol Obstet Hum Reprod 2022; 51:102377. [DOI: 10.1016/j.jogoh.2022.102377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 04/03/2022] [Accepted: 04/07/2022] [Indexed: 11/28/2022]
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Tsakiridis I, Mamopoulos A, Athanasiadis A, Dagklis T. Management of Breech Presentation: A Comparison of Four National Evidence-Based Guidelines. Am J Perinatol 2020; 37:1102-1109. [PMID: 31167240 DOI: 10.1055/s-0039-1692391] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The management of breech presentation may improve perinatal outcomes. The aim of this study was to synthesize and compare published evidence of four national guidelines on breech presentation. STUDY DESIGN A descriptive review of four recently published national guidelines on breech presentation and external cephalic version (ECV) was conducted: Royal College of Obstetricians and Gynaecologists guideline on "External Cephalic Version and Reducing the Incidence of Term Breech Presentation" and "Management of Breech Presentation", American College of Obstetricians and Gynecologists guideline on "External Cephalic Version" and "Mode of Term Singleton Breech Delivery," Society of Obstetricians and Gynaecologists of Canada guideline on "Vaginal Delivery of Breech Presentation" and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists guideline on "Management of breech presentation at term." RESULTS Regarding ECV, there is no recommendation by the SOGC, whereas all other national guidelines recommend this technique. Regarding breech vaginal delivery, there are limited recommendations by the ACOG, whereas all other guidelines provide similar recommendations. The RANZCOG makes no special recommendations on the intrapartum period. CONCLUSION The differences among national guidelines point out the need for the adoption of an international consensus on the management of breech presentation.
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Affiliation(s)
- Ioannis Tsakiridis
- Third Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | - Apostolos Mamopoulos
- Third Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | - Apostolos Athanasiadis
- Third Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | - Themistoklis Dagklis
- Third Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
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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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Ghesquière L, Demetz J, Dufour P, Depret S, Garabedian C, Subtil D. Type of breech presentation and prognosis for delivery. J Gynecol Obstet Hum Reprod 2020; 49:101832. [PMID: 32574703 DOI: 10.1016/j.jogoh.2020.101832] [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: 11/06/2019] [Revised: 05/31/2020] [Accepted: 06/09/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Although its role in the prognosis for delivery remains controversial, the type of breech is sometimes taken into account in the decision about mode of delivery. Objective of our study was to compare maternal and neonatal morbidity for trial of vaginal delivery according to the type of breech (complete or frank). MATERIAL AND METHOD Single-center retrospective study of women with trials of vaginal delivery of a singleton fetus in breech presentation at of after 37 weeks of gestation. Neonatal status was assessed by the composite variable of the Term Breech Trial, first considered alone, and then with the addition of a 5-min Apgar score < 7 or a neonatal arterial pH<7.0. RESULTS Of the 495 trials of vaginal delivery during the study period, approximately one third of them were complete breech (35.8 %) and two thirds frank (64.2 %). The frequency of cesareans during labor was similar regardless of the type of breech (16.4 for complete vs 12.6 % for frank, p=0.24), nor did neonatal morbidity differ (1.7 for complete vs 4.1 % for frank, p=0.15). On the other hand, cord prolapse occurred almost exclusively in complete breech presentations (4.5 vs 0.3 %, p<0.01), and prognosis was good in all cases. Complete breech presentations were also associated with more frequent use of forceps to the after-coming head (16.2 vs 9.7 %, p<0.05). Finally, there were non significant difference between the two types of breech concerning severe acidosis but it seemed to have it more in frank breech (2.3 vs 1.2 %, p=0.34). CONCLUSION Among women eligible for vaginal delivery, the type of breech presentation (complete or frank) has little influence on delivery maternal and neonatal morbidity. The type of breech need not be taken into account in deciding the route of delivery.
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Affiliation(s)
- Louise Ghesquière
- Pôle Femme Mère Nouveau-né, clinique d'obstétrique, Hôpital Jeanne de Flandre, Université Nord de France, Lille, France; EA 4489, Environnement périnatal et croissance. Université Lille Nord de France, F-59000, Lille, France.
| | - Julie Demetz
- Pôle Femme Mère Nouveau-né, clinique d'obstétrique, Hôpital Jeanne de Flandre, Université Nord de France, Lille, France
| | - Philippe Dufour
- Pôle Femme Mère Nouveau-né, clinique d'obstétrique, Hôpital Jeanne de Flandre, Université Nord de France, Lille, France
| | - Sandrine Depret
- Pôle Femme Mère Nouveau-né, clinique d'obstétrique, Hôpital Jeanne de Flandre, Université Nord de France, Lille, France
| | - Charles Garabedian
- Pôle Femme Mère Nouveau-né, clinique d'obstétrique, Hôpital Jeanne de Flandre, Université Nord de France, Lille, France; EA 4489, Environnement périnatal et croissance. Université Lille Nord de France, F-59000, Lille, France
| | - Damien Subtil
- Pôle Femme Mère Nouveau-né, clinique d'obstétrique, Hôpital Jeanne de Flandre, Université Nord de France, Lille, France; EA 2694, Université Lille Nord de France, F-59000, Lille, France
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8
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Benzekri C, Ghesquière L, Drumez E, Houfflin-Debarge V, Subtil D, Garabedian C. [Comparison of antepartum management of breech versus cephalic presentation]. ACTA ACUST UNITED AC 2020; 48:722-728. [PMID: 32335341 DOI: 10.1016/j.gofs.2020.04.010] [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: 08/02/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Delivery mode of term breech presentation is still being discussed. The aim of this study was to compare the labor management of a breech presentation to a vertex presentation during a vaginal delivery attempt. METHODS It was a single-center, comparative, descriptive retrospective study from 2014 to 2017. We studied fetal heart rate (FHR) during labor and expulsion, duration of the different stage of labor, mode of delivery and neonatal outcomes for breech and vertex presentations. RESULTS Two hundred and thirty-nine patients were included whom 106 (44%) breech presentation. The use of oxytocin was more common in breech group (63,2% versus 48,1%, P=0.020). Average dilatation rate was slower for breech presentation than for vertex presentation (1.9cm/h vs. 2.8cm/h; P=0.005). There was more FHR with high risk of acidosis in the breech presentations (37.2% vs 19.1%, P=0.001) and Melchior's FHR classification were comparable in both groups. CONCLUSIONS The per-partum management of a fetus in breech presentation differs from a fetus in cephalic presentation. It must be known and anticipated for an optimal management in the delivery room.
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Affiliation(s)
- C Benzekri
- EA 4489, University Lille, 59000 Lille, France.
| | - L Ghesquière
- EA 4489, University Lille, 59000 Lille, France; Department of obstetrics, CHU de Lille, 59000 Lille, France
| | - E Drumez
- EA 2694 - Public health: epidemiology and quality of care, Department of biostatistics, University of Lille, CHU de Lille, 59000 Lille, France
| | - V Houfflin-Debarge
- EA 4489, University Lille, 59000 Lille, France; Department of obstetrics, CHU de Lille, 59000 Lille, France
| | - D Subtil
- EA 4489, University Lille, 59000 Lille, France
| | - C Garabedian
- EA 4489, University Lille, 59000 Lille, France; Department of obstetrics, CHU de Lille, 59000 Lille, France
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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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10
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Capelle C, Devos P, Caudrelier C, Verpillat P, Fourquet T, Puech P, Garabedian C, Lemaitre L. How reproducible are classical and new CT-pelvimetry measurements? Diagn Interv Imaging 2019; 101:79-89. [PMID: 31473163 DOI: 10.1016/j.diii.2019.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 07/22/2019] [Accepted: 07/31/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The objective of this study was to assess the reliability and reproducibility of existing and new computed tomography (CT)-pelvimetry measurements. MATERIAL AND METHODS A retrospective cohort study of 63 women with a mean age of 33.9±5.2 (SD) years (range: 19-49 years) was conducted. Classical pelvimetry measurements were collected including the obstetric conjugate (OC), median transverse diameter (MTD), and interspinous diameter (ISD). Additionally, we used multiplanar reconstruction (MPR) mode to define two oblique planes: inlet pelvic plane (IPP) and mid-pelvic plane (MPP) and measure new pelvic parameters, including anteroposterior (APD), transverse diameters and circumference of both IPP and MPP (inletAPD, inletMTD, inletCIRC and midAPD, ISD, midCIRC, respectively). The reproducibility (intra- and inter-observer) of our results were assessed. Multivariate analyses using principal component analysis and clustering methods were conducted to analyze the association between pelvimetry measurements and identify patient sub-groups. RESULTS All linear measurements (OC, inletAPD, MTD, inletMTD, midAPD, and ISD) showed statistically "almost perfect" intra- and inter-observer correlation coefficients (range: 0.924-0.980). Circumferences (inletCIRC and midCIRC) showed statistically "almost perfect" intra- (range: 0.847-0.857) and inter-observer correlation coefficients (range: 0.923-0.957). The measurement of 6 pelvimetric parameters allowed determining three groups of pelvis size. CONCLUSION New pelvic measurements have excellent reproducibility and are similar to the classical measurements, based on the MPR analysis of CT planes adjusted to the inner bony pelvis.
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Affiliation(s)
- C Capelle
- Department of Radiology (Women imaging), University of Lille, CHU of Lille, Hospital Jeanne de Flandre, 59000 Lille, France.
| | - P Devos
- EA 2694, Department of Public Health, University of Lille, CHU of Lille, 59000 Lille, France
| | - C Caudrelier
- Department of Obstetrics, University of Lille, CHU of Lille, Hospital Jeanne de Flandre, 59000 Lille, France
| | - P Verpillat
- Department of Radiology (Women imaging), University of Lille, CHU of Lille, Hospital Jeanne de Flandre, 59000 Lille, France
| | - T Fourquet
- Department of Radiology (Women imaging), University of Lille, CHU of Lille, Hospital Jeanne de Flandre, 59000 Lille, France
| | - P Puech
- Department of Radiology (Women imaging), University of Lille, CHU of Lille, Hospital Jeanne de Flandre, 59000 Lille, France
| | - C Garabedian
- EA 4489, Perinatal Environment and Health, University of Lille, 59000 Lille, France; Department of Obstetrics, Hospital Jeanne de Flandre, 59000 Lille, France
| | - L Lemaitre
- Department of Radiology (Women imaging), University of Lille, CHU of Lille, Hospital Jeanne de Flandre, 59000 Lille, France
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Jettestad MC, Schiøtz HA, Yli BM, Kessler J. Fetal monitoring in term breech labor - A review. Eur J Obstet Gynecol Reprod Biol 2019; 239:45-51. [PMID: 31176197 DOI: 10.1016/j.ejogrb.2019.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/09/2019] [Accepted: 05/10/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Marte C Jettestad
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway.
| | - Hjalmar A Schiøtz
- Department of Obstetrics and Gynecology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Branka M Yli
- Department of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway
| | - Jørg Kessler
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway
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Vannerum M, Subtil D, Drumez E, Brochot C, Houfflin-Debarge V, Garabedian C. [Per-partum risk factors of neonatal acidemia in planned vaginal delivery for fetuses in breech presentation]. ACTA ACUST UNITED AC 2018; 47:11-17. [PMID: 30563786 DOI: 10.1016/j.gofs.2018.10.036] [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: 06/05/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Delivery mode of term breech presentation is debated because of higher rate of neonatal acidosis (pH<7.15) in planned vaginal delivery than in planned caesarean section. The objective was to evaluate per-partum risk factors of neonatal acidosis in vaginal delivery for podalic fetuses. METHODS It was a single-centre, case-control retrospective study that included planned vaginal delivery in singleton term breech presentation between 2012 and 2016. The "case" group defined by neonatal pH≤7.10 and the "control" group defined by neonatal pH≥7.20 were matched. The maternal, labor, and neonatal characteristics were noted. RESULTS One hundred and thirty-two patients were included: each of 44 patients in "case" group, has been matched according to breech type (legs position) to 2 patients in the "control" group, so 88. In multivariate analysis, significant risk factors identified were oxytocin use [ORa=5.663 (95% CI=1.844-17.397)], "high risk" fetal heart rate (FHR) abnormalities according to FIGO classification [ORa=10.997 (95% CI=1.864-64.866)] and FHR abnormalities during expulsion, Melchior 2 [ORa=8.088 (95% CI=1.192-54.875)] and Melchior 4 [ORa=12.705 (95% CI=1.157-139.541)]. CONCLUSIONS These risk factors of neonatal acidemia have to be known to improve the labor management in case of breech planned vaginal delivery.
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Affiliation(s)
- M Vannerum
- Clinique d'obstétrique, CHU de Lille, avenue Eugène-Avinée, 59000 Lille, France; EA 4489, faculté de médecine Henri-Warembourg, université de Lille, 2, avenue Eugène-Avinée, 59120 Loos, France.
| | - D Subtil
- Clinique d'obstétrique, CHU de Lille, avenue Eugène-Avinée, 59000 Lille, France; EA 4489, faculté de médecine Henri-Warembourg, université de Lille, 2, avenue Eugène-Avinée, 59120 Loos, France
| | - E Drumez
- EA 2694 - santé publique : épidémiologie et qualité des soins, département de biostatistiques, université de Lille, CHU de Lille, 6, rue du Professeur-Laguesse, 59037 Lille, France
| | - C Brochot
- Maternité, centre hospitalier d'Arras, 3, boulevard Georges-Besnier, 62000 Arras, France
| | - V Houfflin-Debarge
- Clinique d'obstétrique, CHU de Lille, avenue Eugène-Avinée, 59000 Lille, France; EA 4489, faculté de médecine Henri-Warembourg, université de Lille, 2, avenue Eugène-Avinée, 59120 Loos, France
| | - C Garabedian
- Clinique d'obstétrique, CHU de Lille, avenue Eugène-Avinée, 59000 Lille, France; EA 4489, faculté de médecine Henri-Warembourg, université de Lille, 2, avenue Eugène-Avinée, 59120 Loos, France
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Hejl L, Perdriolle-Galet E, Gauchotte E, Callec R, Morel O. [Vaginal delivery in case of breech presentation: Impact of a service's incentive]. ACTA ACUST UNITED AC 2017; 45:596-603. [PMID: 28964728 DOI: 10.1016/j.gofs.2017.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 08/23/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The mode of delivery in podalic presentation was controvertible since the 2000s, which led to a high rate of caesarean section. In our center, the delivery mode was physician-dependent before 2012. Since 2012, the management of podalic presentations was supervised by a protocol allowing a collegiate management to promote vaginal delivery. The objective of this study was to evaluate the impact of this policy on neonatal outcomes and obstetric practices. METHODS A retrospective study was carried out with comparison of 135 patients who gave birth in 2008 with 110 patients who gave birth in 2014, before and after the implementation of the protocol in a type III university maternity hospital. Two hundred and forty-five singleton pregnancies with podalic presentation and a gestational age more than 32 weeks of gestation were included in this study. The rate of vaginal delivery trial, the evolution of clinical practices and neonatal outcomes were respectively compared. RESULTS One hundred and twenty-six patients who gave birth in 2008 were compared to the 105 one of 2014. The rate of successful vaginal birth trial increased from 32.7% (n=16/49) to 63.8% (n=37/58) (P>0.05) between the two periods, this induced a decrease of 16.3% of planned caesarean sections rate [(77/126) versus (47/105) (P<0.02)] and of 6.2% of emergency caesarean sections rate [(33/126) versus (21/105) (P<0.001)]. No significant difference was observed regarding neonatal outcomes. CONCLUSIONS This work shows that it is possible to limit the rate of planned and emergency caesarean sections because of an incentive policy of service without impact on neonatal morbidity and mortality.
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Affiliation(s)
- L Hejl
- Service d'obstétrique et médecine fœtale, maternité du centre hospitalier régional universitaire de Nancy, 10, rue du Dr-Heydenreich, Nancy, France.
| | - E Perdriolle-Galet
- Service d'obstétrique et médecine fœtale, maternité du centre hospitalier régional universitaire de Nancy, 10, rue du Dr-Heydenreich, Nancy, France; Laboratoire IADI, unité Inserm U947, université de Lorraine, 54500 Vandoeuvre-lès-Nancy, France
| | - E Gauchotte
- Service d'obstétrique et médecine fœtale, maternité du centre hospitalier régional universitaire de Nancy, 10, rue du Dr-Heydenreich, Nancy, France
| | - R Callec
- Service d'obstétrique et médecine fœtale, maternité du centre hospitalier régional universitaire de Nancy, 10, rue du Dr-Heydenreich, Nancy, France; Laboratoire IADI, unité Inserm U947, université de Lorraine, 54500 Vandoeuvre-lès-Nancy, France
| | - O Morel
- Service d'obstétrique et médecine fœtale, maternité du centre hospitalier régional universitaire de Nancy, 10, rue du Dr-Heydenreich, Nancy, France; Laboratoire IADI, unité Inserm U947, université de Lorraine, 54500 Vandoeuvre-lès-Nancy, France; France PremUp Foundation, Paris, France
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Is trial of labor harmful in breech delivery? A cohort comparison for breech and vertex presentations. J Gynecol Obstet Hum Reprod 2017; 46:445-448. [DOI: 10.1016/j.jogoh.2017.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 04/03/2017] [Accepted: 04/05/2017] [Indexed: 11/23/2022]
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Bleu G, Demetz J, Michel S, Drain A, Houfflin-Debarge V, Deruelle P, Subtil D. Effectiveness and safety of induction of labor for term breech presentations. J Gynecol Obstet Hum Reprod 2017; 46:29-34. [DOI: 10.1016/j.jgyn.2015.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 11/21/2015] [Accepted: 12/18/2015] [Indexed: 11/25/2022]
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Pronostic obstétrical des présentations podaliques à terme en cas de rupture des membranes avant travail. ACTA ACUST UNITED AC 2016; 45:366-71. [DOI: 10.1016/j.jgyn.2015.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 03/18/2015] [Accepted: 04/15/2015] [Indexed: 11/18/2022]
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Savić-Mitić Ž, Trailović M, Maja C, Mitić D. DELIVERIES WITH BREECH PRESENTATION IN THE HEALTH CENTER ZAJEČAR IN A PERIOD FROM 2004 TO 2013. ACTA MEDICA MEDIANAE 2016. [DOI: 10.5633/amm.2016.0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Bleu G, Subtil D. [G. Bleu and D. Subtil in reply to the correspondence by D. Riethmuller on their article entitled: Assessment of vacuum-assisted delivery in a frank breech presentation. Gynecol Obstet Fertil 2015;43:123-7]. ACTA ACUST UNITED AC 2015; 43:689. [PMID: 26419297 DOI: 10.1016/j.gyobfe.2015.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 08/27/2015] [Indexed: 10/23/2022]
Affiliation(s)
- G Bleu
- Pôle femme-mère-nouveau-né, hôpital Jeanne-de-Flandre, CHRU de Lille, 1, rue Eugène-Avinée, 59037 Lille cedex, France.
| | - D Subtil
- Pôle femme-mère-nouveau-né, hôpital Jeanne-de-Flandre, CHRU de Lille, 1, rue Eugène-Avinée, 59037 Lille cedex, France
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Bleu G, Subtil D. [G. Bleu et D. Subtil in reply to the correspondence by L. Marpeau on their article entitled: Assessment of vacuum-assisted delivery in a Frank breech presentation. Gynecol Obstet Fertil 2015;43:123-7]. ACTA ACUST UNITED AC 2015; 43:334. [PMID: 25819390 DOI: 10.1016/j.gyobfe.2015.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Indexed: 11/28/2022]
Affiliation(s)
- G Bleu
- Pôle femme-mère-nouveau-né, hôpital Jeanne-de-Flandre, CHRU de Lille, 1, rue Eugène-Avinée, 59037 Lille cedex, France.
| | - D Subtil
- Pôle femme-mère-nouveau-né, hôpital Jeanne-de-Flandre, CHRU de Lille, 1, rue Eugène-Avinée, 59037 Lille cedex, France
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Peut-on réaliser une extraction par ventouse obstétricale en cas de fœtus en présentation du siège décomplété ? ACTA ACUST UNITED AC 2015; 43:123-7. [DOI: 10.1016/j.gyobfe.2014.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Indexed: 11/23/2022]
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Garabedian C, Poulain C, Duhamel A, Subtil D, Houfflin-Debarge V, Deruelle P. Intrapartum management of twin pregnancies: are uncomplicated monochorionic pregnancies more at risk of complications than dichorionic pregnancies? Acta Obstet Gynecol Scand 2015; 94:301-7. [PMID: 25494703 DOI: 10.1111/aogs.12558] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Accepted: 12/03/2014] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To analyze mode of delivery and neonatal morbidity according to chorionicity in a hospital birth center with a policy of vaginal delivery for twins. STUDY DESIGN Retrospective analysis over a 13-year period. SETTING Department of Obstetrics, University Hospital, Lille, France. POPULATION In all, 1009 twin pregnancies were included, divided into 171 uncomplicated monochorionic pregnancies (17%) and 838 dichorionic pregnancies (83%). METHODS We compared the monochorionic and the dichorionic populations. MAIN OUTCOME MEASURES Rate of cesarean section and neonatal outcome (umbilical artery pH, Apgar score and neonatal complications). RESULTS The rate of cesarean sections was 45.7% with no difference found based on chorionicity. The reasons for elective cesarean section were mainly noncephalic presentation, which was more frequent in dichorionic than in monochorionic (48.8% vs. 37.2%, p = 0.025) pregnancies. Birthweight was lower in monochorionic twins (2249 ± 469 g vs. 2329 ± 478 g, p = 0.045). The rate of umbilical artery cord blood values with a pH < 7.10 was similar in monochorionic and dichorionic pregnancies. There was no difference in neonatal complications between the two groups. CONCLUSION Monochorionic and dichorionic twin pregnancies had similar delivery outcomes. The neonatal outcome for twin 2 was not different between monochorionic and dichorionic pregnancies. Vaginal birth could be offered to women with twin pregnancies regardless of chorionicity.
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Affiliation(s)
- Charles Garabedian
- Department of Obstetrics, Jeanne de Flandre Hospital, Lille, France; Unit EA 4489 Perinatal Environment and Growth, Faculty of Medicine, Henri-Warembourg, University of Lille, Lille, France
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Vlemmix F, Bergenhenegouwen L, Schaaf JM, Ensing S, Rosman AN, Ravelli ACJ, Van Der Post JAM, Verhoeven A, Visser GH, Mol BWJ, Kok M. Term breech deliveries in the Netherlands: did the increased cesarean rate affect neonatal outcome? A population-based cohort study. Acta Obstet Gynecol Scand 2014; 93:888-96. [PMID: 25113411 DOI: 10.1111/aogs.12449] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 06/25/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the effect of the increased cesarean rate for term breech presentation on neonatal outcome. We also investigated whether the clinical case selection for vaginal delivery applied by Dutch obstetricians led to an optimization of neonatal outcome, or whether there is still room for improvement in terms of perinatal outcome. DESIGN Retrospective cohort. SETTING The Netherlands. POPULATION Singleton term breech deliveries from 37+0 to 41+6 weeks, excluding fetuses with congenital malformations or antenatal death. METHOD We used data from the Dutch national perinatal registry from 1999 up to 2007. MAIN OUTCOME MEASURES Perinatal mortality and morbidity. RESULTS We studied 58,320 women with a term breech delivery. There was an increase in the elective cesarean rate (from 24 to 60%). As a consequence, overall perinatal mortality decreased [1.3 0/00 vs. 0.7 0/00;odds ratio 0.51 (95% confidence interval 0.28–0.93)], whereas it remained stable in the planned vaginal birth group [1.7 0/00 vs. 1.6 0/00; odds ratio 0.96(95% confidence interval 0.52–1.76)]. The number of cesareans done to prevent one perinatal death was 338. CONCLUSIONS Adjustment of the national guidelines after publication of the Term Breech Trial resulted in a shift towards elective cesarean and a decrease of perinatal mortality and morbidity among women delivering a child in breech at term. Still, 40% of these women attempt vaginal birth. The relative safety of an elective cesarean should be weighed against the consequences of a scarred uterus in future pregnancies.
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Bleu G, Wery E, Deruelle P, Subtil D. [Zavanelli maneuver in a breech presentation: to be kept in mind]. ACTA ACUST UNITED AC 2014; 42:729-31. [PMID: 25155905 DOI: 10.1016/j.gyobfe.2014.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 07/09/2014] [Indexed: 11/25/2022]
Abstract
Since its first description in 1980, the Zavanelli maneuver - reintroduction of the fetus in the uterus after failure of maneuver to reduce shoulder dystocia - remains an extraordinary and nearly unknown remedy. We report a Zavanelli maneuver performed in a case of irreducible raising arm of a fetus in breech presentation. Literature and our observation indicate that fetal and neonatal prognosis in Zavanelli maneuver is pretty good if breech presentation. This exceptional situation should remain in mind of obstetricians.
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Affiliation(s)
- G Bleu
- Pôle Femme-Mère-Nouveau-né, pôle d'anesthésie-réanimation, hôpital Jeanne-de-Flandre, université Lille Nord de France, 1, rue Eugène-Avinée, 59037 Lille cedex, France.
| | - E Wery
- Pôle Femme-Mère-Nouveau-né, pôle d'anesthésie-réanimation, hôpital Jeanne-de-Flandre, université Lille Nord de France, 1, rue Eugène-Avinée, 59037 Lille cedex, France
| | - P Deruelle
- Pôle Femme-Mère-Nouveau-né, pôle d'anesthésie-réanimation, hôpital Jeanne-de-Flandre, université Lille Nord de France, 1, rue Eugène-Avinée, 59037 Lille cedex, France; EA 4489, faculté de médecine Henri-Warembourg, université Lille 2, UPRES Lille Nord de France, 59000 Lille, France
| | - D Subtil
- Pôle Femme-Mère-Nouveau-né, pôle d'anesthésie-réanimation, hôpital Jeanne-de-Flandre, université Lille Nord de France, 1, rue Eugène-Avinée, 59037 Lille cedex, France; EA2694, UDSL, Univ Lille Nord de France, CHU de Lille, 59000 Lille, France
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Wery E, Le Roch A, Subtil D. Zavanelli maneuver performed in a breech presentation. Int J Gynaecol Obstet 2012; 120:193. [PMID: 23265832 DOI: 10.1016/j.ijgo.2012.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 08/24/2012] [Accepted: 10/23/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Edwige Wery
- Pôle Femme Mère Nouveau-né, Hôpital Jeanne de Flandre, Université Lille Nord de France, Lille Cedex, France.
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TOIVONEN ELLI, PALOMÄKI OUTI, HUHTALA HEINI, UOTILA JUKKA. Selective vaginal breech delivery at term - still an option. Acta Obstet Gynecol Scand 2012; 91:1177-83. [DOI: 10.1111/j.1600-0412.2012.01488.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Voskamp BJ, Pajkrt E, Mol BW. Letter to the editor of "Evaluation on a decision protocol for type of delivery of infants in breech presentation at term" from S. Michel and colleagues. Eur J Obstet Gynecol Reprod Biol 2011; 171:e5. [PMID: 22133890 DOI: 10.1016/j.ejogrb.2011.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 11/06/2011] [Indexed: 11/16/2022]
Affiliation(s)
- B J Voskamp
- Department of Obstetrics and Gynaecology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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