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Allert R, Brüggmann D, Raimann FJ, Zander N, Louwen F, Jennewein L. The influence of epidural anesthesia in pregnancies with scheduled vaginal breech delivery at term: a hospital-based retrospective analysis. Arch Gynecol Obstet 2024; 310:261-268. [PMID: 37982831 PMCID: PMC11169086 DOI: 10.1007/s00404-023-07244-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 09/20/2023] [Indexed: 11/21/2023]
Abstract
INTRODUCTION Epidural anesthesia is a well-established procedure in obstetrics for pain relief in labor and has been well researched as it comes to cephalic presentation. However, in vaginal intended breech delivery less research has addressed the influence of epidural anesthesia. The Greentop guideline on breech delivery states that there's little evidence and recommends further evaluation. OBJECTIVE The aim of this study was to compare maternal and neonatal outcomes in vaginally intended breech deliveries at term with and without an epidural anesthesia. DESIGN This study was a retrospective cohort study. SAMPLE This study included 2122 women at term with a singleton breech pregnancy from 37 + 0 weeks of pregnancy on and a birth weight of at least 2500 g at the obstetric department of University hospital Frankfurt from January 2007 to December 2018. METHODS Neonatal and maternal outcome was analyzed and compared between women receiving "walking" epidural anesthesia and women without an epidural anesthesia. RESULTS Fetal morbidity, measured with a modified PREMODA score, showed no significant difference between deliveries with (2.96%) or without (1.79%; p = 0.168) an epidural anesthesia. Cesarean delivery rates were significantly higher in deliveries with an epidural (35 vs. 26.2%, p = 0.0003), but after exclusion of multiparous women, cesarean delivery rates were not significantly different (40.2% cesarean deliveries with an epidural vs. 41.5%, p = 0.717). As compared to no epidurals, epidural anesthesia in vaginal delivery was associated with a significantly higher rate of manual assistance (33.8 versus 52.1%) and a longer duration of birth (223.7 ± 194 versus 516.2 ± 310 min) (both p < 0.0001)". CONCLUSION Epidural anesthesia can be offered as a safe option for pain relief without increasing neonatal or maternal morbidity and mortality. Nevertheless, it is associated with a longer birth duration and manually assisted delivery.
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Affiliation(s)
- Roman Allert
- Department of Obstetrics and Gynecology, University Hospital Frankfurt, Goethe University, 60590, Frankfurt, Germany.
| | - Dörthe Brüggmann
- Department of Obstetrics and Gynecology, University Hospital Frankfurt, Goethe University, 60590, Frankfurt, Germany
| | - Florian J Raimann
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, 60590, Frankfurt, Germany
| | - Nadja Zander
- Department of Midwifery Frankfurt, Goethe University, 60590, Frankfurt, Germany
| | - Frank Louwen
- Department of Obstetrics and Gynecology, University Hospital Frankfurt, Goethe University, 60590, Frankfurt, Germany
| | - Lukas Jennewein
- Department of Obstetrics and Gynecology, University Hospital Frankfurt, Goethe University, 60590, Frankfurt, Germany
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Jennewein L, Agel L, Hoock SC, Hentrich AE, Louwen F, Zander N. Does overweight and obesity have an impact on delivery mode and peripartum outcome in breech presentation? A FRABAT cohort study. Arch Gynecol Obstet 2024; 310:285-292. [PMID: 38498162 PMCID: PMC11168971 DOI: 10.1007/s00404-024-07403-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/24/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE Obesity is a worldwide and growing issue affecting women in childbearing age, complicating surgical procedures as well as pregnancy. Through a reduction of not necessarily required cesarean deliveries-for instance in pregnancies with breech presentation-obesity mediated and surgery-associated morbidity might be contained. Date on the impact of maternal BMI in vaginally attempted breech delivery is not existing. To give insight into whether an elevated BMI leads to an increased perinatal morbidity in vaginally intended deliveries out of breech presentation, we analyzed delivery outcome of laboring women with a singleton baby in breech presentation with overweight and obesity (BMI ≥ 25 kg/m2) in comparison to women with a BMI of below 25 kg/m2. METHODS Based on data from January 2004 to December 2020, a cohort study was performed on 1641 women presenting with breech presentation at term (> 37 weeks). The influence of maternal BMI on perinatal outcome was analyzed with Chi2 testing for group differences and logistic regression analysis. Patients with a hyperglycemic metabolism were excluded from the study. RESULTS Fetal morbidity was not different when patients with a BMI of ≥ 25 kg/m2 (PREMODA morbidity score 2.16%) were compared to patients with a BMI of below 25 kg/m2 (1.97%, p = 0.821). Cesarean delivery rates were significantly higher in overweight and obese women with 43.9% compared to 29.3% (p < 0.0001). BMI and cesarean delivery were significantly associated in a logistic regression analysis (Chi2 coefficient 18.05, p < 0.0001). In successful vaginal deliveries out of breech presentation, maternal perineal injury rates (vaginal birth in normal-BMI women 48.4%; vaginal birth in overweight and obese women: 44.2%; p = 0.273) and rates of manually assisted delivery (vaginal birth in normal-BMI women: 44.4%; vaginal birth in obese and overweight women: 44.2%; p = 0.958) were not different between BMI groups. CONCLUSIONS Obesity and overweight are not associated with peripartum maternal or newborn morbidity in vaginally attempted breech delivery, if the patient cohort is thoroughly selected and vaginal breech delivery is in an upright maternal position. Reduction of cesarean delivery rates, especially in overweight and obese women might, have an important positive impact on maternal and newborn morbidity.
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Affiliation(s)
- Lukas Jennewein
- Department of Obstetrics and Perinatal Medicine, University Hospital, Goethe University Frankfurt, 60590, Frankfurt, Germany.
| | - Lena Agel
- Department of Obstetrics and Perinatal Medicine, University Hospital, Goethe University Frankfurt, 60590, Frankfurt, Germany
| | - Samira Catharina Hoock
- Department of Obstetrics and Perinatal Medicine, University Hospital, Goethe University Frankfurt, 60590, Frankfurt, Germany
| | - Anna Elisabeth Hentrich
- Department of Obstetrics and Perinatal Medicine, University Hospital, Goethe University Frankfurt, 60590, Frankfurt, Germany
| | - Frank Louwen
- Department of Obstetrics and Perinatal Medicine, University Hospital, Goethe University Frankfurt, 60590, Frankfurt, Germany
| | - Nadja Zander
- Department of Obstetrics and Perinatal Medicine, University Hospital, Goethe University Frankfurt, 60590, Frankfurt, Germany
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Jennewein L, Heemann R, Hoock SC, Hentrich AE, Eichbaum C, Feidicker S, Louwen F. Sonographic examination at the beginning of the second stage of labor predicts birth outcome in vaginally intended breech deliveries: a blinded prospective study. Arch Gynecol Obstet 2024; 309:1333-1340. [PMID: 36961567 PMCID: PMC10894138 DOI: 10.1007/s00404-023-07011-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 03/13/2023] [Indexed: 03/25/2023]
Abstract
PURPOSE In order to spread competence in vaginal breech deliveries, it is necessary to develop new and easily applicable tools for birth progression and safety evaluation. Ultrasound is a useful and ubiquitously available tool with already documented value for birth progression observation. In deliveries out of breech presentation, an established ultrasound examination is missing. We determined the descent of the fetal buttocks in relation to the maternal pelvic inlet using intrapartum ultrasound. We evaluated these results in comparison to the clinical vaginal examination with the aim to establish an easily applicable method for birth outcome prediction. Therefore, we analyzed the predictive value of our examinations on birth outcome parameters, such as cesarean section rate, as well as fetal and maternal outcome parameters. METHODS We performed a prospective blinded study on 106 mothers with vaginally intended breech delivery. At beginning of stage two in labor, the descent of the fetal buttocks into the mother's pelvic inlet was detected with transabdominal ultrasound and vaginal examination by different observers. PRIMARY OUTCOME VARIABLE Cesarean section rate. Secondary outcome variables: rate of manual assistance in vaginal deliveries, birth duration, 5' APGAR score, umbilical arterial pH, maternal blood loss, and perineal injury. For non-parametric values, Wilcoxon's χ2 test was performed. In order to analyze the predictive value of our examination, lack-of-fit analysis was conducted. Reliability evaluation of the sonographic examination was done with a matched-pair analysis. RESULTS Women with positive intrapartum ultrasound breech engagement sign (+ IPUBES) had a significantly lower rate of cesarean section in comparison with those with negative IPUBES (5/67; 7.5% vs. 18/39; 46.2%; p < 0.0001). The area under the ROC curve for the prediction of CS for negative IPUBES was 0.765 with a sensitivity of 78.3% and a specificity of 74.7%. Sonographic examination showed an excellent reliability in a matched-pair analysis comparing vaginal and sonographic examinations with a mean difference of 0.012 (SD ± 0.027, 95% CI - 0.014 to 0.065). Mean birth duration was significantly longer in deliveries with negative IPUBES (533 min vs. 440 min; p = 0.0011). Fetal and maternal outcome parameters were not significantly different between deliveries with positive and negative IPUBES. CONCLUSIONS Sonographic evaluation of the fetal descent in relation to the mother's pelvic inlet screens reliably for emergency cesarean section. This newly presented method for birth progression observation might be a powerful tool for distribution of expertise in vaginal breech delivery and is able to give reference for clinical vaginal examination by obstetricians in training. TRAIL REGISTRY Clinical trial. Date of registration: 13.03.2019; Date of initial participant enrollment: 20.03.2019; DRKS00016885; https://www.drks.de ; German clinical trials register.
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Affiliation(s)
- Lukas Jennewein
- Department of Gynecology and Obstetrics, School of Medicine, Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
| | - Ricarda Heemann
- Department of Gynecology and Obstetrics, School of Medicine, Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Samira Catharina Hoock
- Department of Gynecology and Obstetrics, School of Medicine, Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Anna Elisabeth Hentrich
- Department of Gynecology and Obstetrics, School of Medicine, Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Christine Eichbaum
- Department of Gynecology and Obstetrics, School of Medicine, Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Susanne Feidicker
- Department of Gynecology and Obstetrics, School of Medicine, Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Frank Louwen
- Department of Gynecology and Obstetrics, School of Medicine, Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
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Dathan-Stumpf A, Lia M, Meigen C, Bornmann K, Martin M, Aßmann M, Kiess W, Stepan H. Novel Three-Dimensional Body Scan Anthropometry versus MR-Pelvimetry for Vaginal Breech Delivery Assessment. J Clin Med 2023; 12:6181. [PMID: 37834825 PMCID: PMC10573905 DOI: 10.3390/jcm12196181] [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: 08/23/2023] [Revised: 09/21/2023] [Accepted: 09/23/2023] [Indexed: 10/15/2023] Open
Abstract
In this prospective, monocentric study, we investigated the potency of a novel three-dimensional (3D) body scanner for external pelvic assessment in birth planning for intended vaginal breech delivery. Between April 2021 and June 2022, 73 singleton pregnancies with intended vaginal birth from breech presentation (>36.0 weeks of gestation) were measured using a pelvimeter by Martin, a three-dimensional body scanner, and MR-pelvimetry. Measures were related to vaginal birth and intrapartum cesarean section. A total of 26 outer pelvic dimensions and 7 inner pelvic measurements were determined. The rate of successful vaginal breech delivery was 56.9%. The AUC (area under the curve) of the obstetric conjugate (OC) measured by MRI for predicting the primary outcome was 0.62 (OR 0.63; p = 0.22), adjusted for neonatal birth weight 0.66 (OR 0.60; p = 0.19). Of the 22 measured 3D body scanner values, the ratio of waist girth to maternal height showed the best prediction (AUC = 0.71; OR 1.27; p = 0.015). The best predictive pelvimeter value was the distantia spinarum with an AUC of 0.65 (OR = 0.80). The 3D body scanner technique is at least equal to predict successful vaginal breech delivery compared to MRI diagnostics. Further large-scale, prospective studies are needed to verify these results.
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Affiliation(s)
- Anne Dathan-Stumpf
- Department of Obstetrics, University Hospital Leipzig, 04103 Leipzig, Germany; (M.L.); (K.B.); (H.S.)
| | - Massimiliano Lia
- Department of Obstetrics, University Hospital Leipzig, 04103 Leipzig, Germany; (M.L.); (K.B.); (H.S.)
| | - Christof Meigen
- LIFE Leipzig Research Center for Civilization Diseases, University of Leipzig, 04103 Leipzig, Germany; (C.M.); (M.A.); (W.K.)
| | - Karoline Bornmann
- Department of Obstetrics, University Hospital Leipzig, 04103 Leipzig, Germany; (M.L.); (K.B.); (H.S.)
| | - Mireille Martin
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, 04103 Leipzig, Germany;
| | - Manuela Aßmann
- LIFE Leipzig Research Center for Civilization Diseases, University of Leipzig, 04103 Leipzig, Germany; (C.M.); (M.A.); (W.K.)
| | - Wieland Kiess
- LIFE Leipzig Research Center for Civilization Diseases, University of Leipzig, 04103 Leipzig, Germany; (C.M.); (M.A.); (W.K.)
- Department of Pediatrics, University Hospital Leipzig, 04103 Leipzig, Germany
| | - Holger Stepan
- Department of Obstetrics, University Hospital Leipzig, 04103 Leipzig, Germany; (M.L.); (K.B.); (H.S.)
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Jennewein L, Brüggmann D, Fischer K, Raimann FJ, Pfeifenberger HR, Agel L, Zander N, Eichbaum C, Louwen F. Learning Breech Birth in an Upright Position Is Influenced by Preexisting Experience-A FRABAT Prospective Cohort Study. J Clin Med 2021; 10:2117. [PMID: 34068873 PMCID: PMC8153626 DOI: 10.3390/jcm10102117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/29/2021] [Accepted: 05/12/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Vaginal breech delivery is becoming an extinct art although national guidelines underline its safety and vaginal breech delivery in an upright position has been shown to be a safe birth mode option. In order to spread clinical knowledge and be able to implement vaginal breech delivery into obstetricians' daily practice, we need to gather knowledge from facilities who teach specialized obstetrical management. METHODS We performed a prospective cohort study on 140 vaginal deliveries out of breech presentation solely-managed by seven newly-trained physicians and compared fetal outcome as well as rates of manual assistance in respect to preexisting experience. RESULTS Fetal morbidity rate measured with a modified PREMODA score was not significantly different in three sub-cohorts sorted by preexisting expertise levels of managing obstetricians (experience groups EG, EG0: 2, 5%; EG1: 3, 7.5%; EG2: 1, 1.7%; p = 0.357). Manual assistance rate was significantly higher in EG1 (low experience level in breech delivery and only in dorsal position) compared to EG0 and EG2 (EG1 28, 70%; EG0: 14, 25%; EG2: 21, 35%; p = 0.0008). CONCLUSIONS Our study shows that vaginal breech delivery with newly-trained obstetricians is a safe option whether or not they have advanced preexisting expertise in breech delivery. These data should encourage implementing vaginal breech delivery in clinical routine.
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Affiliation(s)
- Lukas Jennewein
- Department of Gynecology and Obstetrics, School of Medicine, Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany; (D.B.); (K.F.); (H.R.P.); (C.E.); (F.L.)
| | - Dörthe Brüggmann
- Department of Gynecology and Obstetrics, School of Medicine, Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany; (D.B.); (K.F.); (H.R.P.); (C.E.); (F.L.)
| | - Kyra Fischer
- Department of Gynecology and Obstetrics, School of Medicine, Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany; (D.B.); (K.F.); (H.R.P.); (C.E.); (F.L.)
| | - Florian J. Raimann
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, 60590 Frankfurt, Germany;
| | - Hemma Roswitha Pfeifenberger
- Department of Gynecology and Obstetrics, School of Medicine, Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany; (D.B.); (K.F.); (H.R.P.); (C.E.); (F.L.)
| | - Lena Agel
- Carl Remigus Medical School, Limburger Straße 2, 65510 Idstein, Germany; (L.A.); (N.Z.)
| | - Nadja Zander
- Carl Remigus Medical School, Limburger Straße 2, 65510 Idstein, Germany; (L.A.); (N.Z.)
| | - Christine Eichbaum
- Department of Gynecology and Obstetrics, School of Medicine, Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany; (D.B.); (K.F.); (H.R.P.); (C.E.); (F.L.)
| | - Frank Louwen
- Department of Gynecology and Obstetrics, School of Medicine, Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany; (D.B.); (K.F.); (H.R.P.); (C.E.); (F.L.)
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