[Breech delivery and scarred uterus: a special obstetrical situation?]

Trial of Labor After Cesarean Section Among Women with Unique Lower Segment Scarred Uterus and Fetal Weight >3500 g: Prognostic Factors for a Safe Vaginal Delivery

OBJECTIVE

To evaluate outcome of trial of labor after cesarean section (TOLAC) with fetal weight >3500 g.

MATERIALS AND METHODS

This retrospective descriptive study was carried out between March 1, 2012, and February 28, 2015. Medical and obstetrical records of women with birth weight (BW) >3500 g admitted in the labor ward with advanced labor or admitted in early labor but with underestimated fetal weight >3500 g were analyzed. Main variables analyzed included maternal parity, vaginal delivery prior to TOLAC, the BW and the integrity of the uterine scar.

RESULTS

Mean BW was 3789.3 g. Out of 36 women, 75 % had a successful TOLAC. Women who delivered vaginally before TOLAC had a higher success rate than women who never delivered vaginally (94.1 vs. 63.1 %, P < 0.044).

CONCLUSION

Successful TOLAC with birth weight >3500 g can be observed among women, especially among those admitted in advanced labor or with successful vaginal delivery prior to the current TOLAC.

Humerus Diaphysis Fracture in a Newborn during Vaginal Breech Delivery

While most obstetricians are familiar with fracture of the clavicle in newborns during birth, an unlucky minority of obstetricians has encountered long-bone fractures in newborns as well. This complication is traumatic not only for the neonate, but also for the family and the obstetrician; it is also difficult to explain. Fortunately, the long-term prognosis for fracture of the long bones is excellent. Both vaginal and cesarean breech deliveries and maneuvers can be responsible for birth traumas, including long-bone fractures. This case report presents a newborn with breech presentation delivered vaginally that resulted in humerus diaphysis fracture.