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Long F, Yan K, Guo D, Zhaxi D, Xu X, Sun Z, Xiao Z. Term breech presentation vaginal births in Tibet: A retrospective analysis of 451 cases. Front Med (Lausanne) 2023; 10:1048628. [PMID: 37138741 PMCID: PMC10150607 DOI: 10.3389/fmed.2023.1048628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 03/06/2023] [Indexed: 05/05/2023] Open
Abstract
Background In high altitude areas, like Tibet, most fetuses in breech presentation at term are delivered vaginally owing to a variety of reasons, but this has not been published. Objective This study aimed to provide references and evidence for the delivery of breach presentation term fetuses in high altitude areas, through comparing and analyzing the data of full-term singleton fetuses with breech or cephalic presentation in Naqu People's Hospital, Tibet. Study design We retrospectively analyzed the clinical data of 451 breech presentation fetuses mentioned above over a period of 5 years (2016-2020). A total of 526 cephalic presentation fetuses' data within 3 months (1 June to 1 September 2020) of the same period were collected too. Statistics were compared and assembled on fetal mortality, Apgar scores, and severe neonatal complications for both planned cesarean section (CS) and vaginal delivery. In addition, we also analyzed the types of breech presentation, the second stage of labor, and damage to the maternal perineum during vaginal delivery. Results Among the 451 cases of breech presentation fetuses, 22 cases (4.9%) elected for CS and 429 cases (95.1%) elected for vaginal delivery. Of the women who chose vaginal trial labor, 17 cases underwent emergency CSs. The perinatal and neonatal mortality rate was 4.2% in the planned vaginal delivery group and the incidence of severe neonatal complications was 11.7% in the transvaginal group, no deaths were detected in the CS group. Among the 526 cephalic control groups with planned vaginal delivery, the perinatal and neonatal mortality was 1.5% (p = 0.012), and the incidence of severe neonatal complications was 1.9%. Among vaginal breech deliveries, most of them were complete breech presentation (61.17%). Among the 364 cases, the proportion of intact perinea was 45.1%, and first degree lacerations accounted for 40.7%. Conclusion In the Tibetan Plateau region, vaginal delivery was less safe than cephalic presentation fetuses for full-term breech presentation fetuses delivered in the lithotomy position. However, if dystocia or fetal distress can be identified in time and then encouraged to convert to cesarean, its safety will be greatly improved.
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Affiliation(s)
- Fang Long
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Dalian Medical University, Dalian, China
- Department of Obstetrics and Gynecology, People’s Hospital of Naqu, Tibet, China
| | - Keqing Yan
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Dongxing Guo
- Department of Obstetrics and Gynecology, People’s Hospital of Naqu, Tibet, China
| | - Duoji Zhaxi
- Research Center of High Altitude Medicine of Naqu, Tibet, China
| | - Xiaoguang Xu
- Research Center of High Altitude Medicine of Naqu, Tibet, China
- Institute of High Altitude Medicine, People’s Hospital of Naqu, Tibet, China
- Xiaoguang Xu :
| | - Zhigang Sun
- Department of Pathology, First Affiliated Hospital of Dalian Medical University, Dalian, China
- Zhigang Sun,
| | - Zhen Xiao
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Dalian Medical University, Dalian, China
- Department of Obstetrics and Gynecology, People’s Hospital of Naqu, Tibet, China
- Research Center of High Altitude Medicine of Naqu, Tibet, China
- *Correspondence: Zhen Xiao, :
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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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Maternal Preference, Mode of Delivery and Associated Factors among Women Who Gave Birth at Public and Private Hospitals in Hawassa City, Southern Ethiopia. Ann Glob Health 2019; 85. [PMID: 31441629 PMCID: PMC6706999 DOI: 10.5334/aogh.2578] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: Despite the advances in modern obstetrics care, maternal morbidity and mortality remains a big problem. Proper choice in the mode of delivery is necessary to tackle this problem. The aim of this study was to assess maternal preference, mode of delivery and associated factors among women who gave birth at public and private hospitals in Hawassa city, Southern Ethiopia, 2017. Methods: A hospital based cross sectional study was carried out from January 01–30/2017. A systematic sampling procedure was utilized, and 300 mothers who gave births were included in the study. Data entered to EPI data 3.5.1 and exported to version 20.0 software packages for social science analysis. The presence of association between independent and dependent variables was determined using odds ratio at 95% confidence interval by applying logistic regression model. Results: The prevalence of caesarean section was 49.3% (95% CI: 43.7–55.3). Mothers that have a monthly income above poverty line, having previous pregnancy complications, and current pregnancy problems have higher odds of using the caesarean section mode of delivery. Whereas utilization of partograph lower the odds of caesarean section mode of delivery. Having previous pregnancy complications had higher odds of maternal preference for caesarean section delivery whereas the utilization of partograph lowered the odds of maternal preference for Caesarean section delivery. Conclusion: The prevalence of caesarean section mode of delivery in Hawassa city was high compared with world health organization threshold. Monthly income above poverty line, previous pregnancy complications, Current obstetrics problems are increasing caesarean section delivery, whereas utilization of partograph is decreasing caesarean section delivery. Therefore, utilization of partograph could be lessening unnecessary caesarean section delivery.
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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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Berhan Y, Haileamlak A. The risks of planned vaginal breech delivery versus planned caesarean section for term breech birth: a meta-analysis including observational studies. BJOG 2015; 123:49-57. [DOI: 10.1111/1471-0528.13524] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Y Berhan
- Hawassa University College of Medicine and Health Sciences; Hawassa Ethiopia
| | - A Haileamlak
- Jimma University College of Public Health and Medicine; Jimma Ethiopia
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Kessler J, Moster D, Albrechtsen S. Intrapartum monitoring with cardiotocography and ST-waveform analysis in breech presentation: an observational study. BJOG 2014; 122:528-35. [DOI: 10.1111/1471-0528.12989] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2014] [Indexed: 11/28/2022]
Affiliation(s)
- J Kessler
- Department of Obstetrics and Gynaecology; Haukeland University Hospital; Bergen Norway
- Department of Clinical Science; Research Group for Pregnancy, Fetal Development and Birth; University of Bergen; Bergen Norway
| | - D Moster
- Department of Health Registries; Norwegian Institute of Public Health; Bergen Norway
- Department of Paediatrics; Haukeland University Hospital; Bergen Norway
- Department of Global Public Health and Primary Care; University of Bergen; Bergen Norway
| | - S Albrechtsen
- Department of Obstetrics and Gynaecology; Haukeland University Hospital; Bergen Norway
- Department of Clinical Science; Research Group for Pregnancy, Fetal Development and Birth; University of Bergen; Bergen Norway
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Vistad I, Cvancarova M, Hustad BL, Henriksen T. Vaginal breech delivery: results of a prospective registration study. BMC Pregnancy Childbirth 2013; 13:153. [PMID: 23883361 PMCID: PMC3728003 DOI: 10.1186/1471-2393-13-153] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 07/16/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most countries recommend planned cesarean section in breech deliveries, which is considered safer than vaginal delivery. As one of few countries in the western world Norway has continued to practice planned vaginal delivery in selected women. The aim of this study is to evaluate prospectively registered neonatal and maternal outcomes in term singleton breech deliveries in a Norwegian hospital during a ten years period. We aim to compare maternal and neonatal outcomes in term breech pregnancies subjected either to planned vaginal or elective cesarean section. METHODS A prospective registration study including 568 women with term breech deliveries (>37 weeks) consecutively registered at Sorlandet Hospital Kristiansand between 2001 and 2011. Fetal and maternal outcomes were compared according to delivery method; planned vaginal delivery versus planned cesarean section. RESULTS Of 568 women, elective cesarean section was planned in 279 (49%) cases and vaginal delivery was planned in 289 (51%) cases. Acute cesarean section was performed in 104 of the planned vaginal deliveries (36.3%). There were no neonatal deaths. Two cases of serious neonatal morbidity were reported in the planned vaginal group. One infant had seizures, brachial plexus injury, and cephalhematoma. The other infant had 5-minutes Apgar < 4. Twenty-nine in the planned vaginal group (10.0%) and eight in the planned cesarean section group (2.9%) (p < 0.001) were transferred to the neonatal intensive care unit. However, only one infant was admitted for ≥4 days. According to follow-up data (median six years) none of these infants had long-term sequelae. Regarding maternal morbidity, blood loss was the only variable that was significantly higher in the planned cesarean section group versus in the vaginal delivery group (p < 0.001). CONCLUSIONS Strict guidelines were followed in all cases. There were no neonatal deaths. Two infants had serious neonatal morbidity in the planned vaginal group without long-term sequelae.
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Abstract
In 2000, the Term Breech Trial was published, and its authors recommended cesarean section as the safest mode of delivery for breech-presenting babies. Criticisms of the trial were raised at the time, which the authors dismissed. Since then, maternal deaths have been recorded among women undergoing cesarean sections for breech presentations. Accordingly, those initial criticisms deserve to be revisited.
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Affiliation(s)
- Gerald W Lawson
- Gerald W. Lawson is a former Consultant in Obstetrics and Gynaecology at John Hunter Hospital, Newcastle, New South Wales, Australia
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HARTNACK THARIN JULIEE, RASMUSSEN STEEN, KREBS LONE. Consequences of the Term Breech Trial in Denmark. Acta Obstet Gynecol Scand 2011; 90:767-71. [DOI: 10.1111/j.1600-0412.2011.01143.x] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Andersen GL, Irgens LM, Skranes J, Salvesen KA, Meberg A, Vik T. Is breech presentation a risk factor for cerebral palsy? A Norwegian birth cohort study. Dev Med Child Neurol 2009; 51:860-5. [PMID: 19469792 DOI: 10.1111/j.1469-8749.2009.03338.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM To study whether breech presentation is a risk factor for cerebral palsy (CP). METHODS Perinatal data from 177 272 children born in breech or vertex presentation in Norway during 1996 to 1998 were retrieved from the Medical Birth Registry of Norway. Data were collected between 1 January 2003 and 31 March 2006. Data on 245 children with CP were recorded in the Norwegian Cerebral Palsy Registry. Odds ratios (OR) with 95% confidence intervals (CI) for CP among children born in breech compared with vertex presentation were calculated. Confounding was addressed in logistic regression and stratified analyses. RESULTS Among the 245 children with CP (46.5% females and 53.5% males), 31% had unilateral, 49% bilateral, 7% dyskinetic, and 5% the ataxic subtype, and 8% of cases were unclassified. Among children born in breech, the OR for CP was 3.6 (95% CI 2.4-5.3). The increased risk was reduced when adjusted for preterm birth, plurality, and smallness for gestational age. Among singletons born in breech by vaginal delivery at term, the OR for CP was 3.9 (95% CI 1.6-9.7). Severity or subtype of CP did not differ between breech and vertex presentation. INTERPRETATION Breech delivery is a significant risk factor for CP, in particular among singletons born by vaginal delivery at term.
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Affiliation(s)
- Guro L Andersen
- Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
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Tollånes MC. [Increased rate of Caesarean sections--causes and consequences]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2009; 129:1329-31. [PMID: 19561658 DOI: 10.4045/tidsskr.08.0453] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND A rise in the rate of caesarean sections has been observed in most parts of the developed world during the last decades. Causes and consequences are much debated. MATERIAL AND METHODS Non-systematic literature search in PubMed. RESULTS The increased rate of caesarean sections can be explained by both medical non-medical factors. Among the medical factors are increases in maternal age and body mass index, as well as changes in obstetric practise and technology. Some non-medical factors are caesarean section requested by the mother, fear of litigation among caregivers and inappropriate organization of maternity care. Caesarean section is associated with maternal postpartum morbidity, reduced fertility and placental complications in a subsequent pregnancy. For the child, caesarean section is associated with postpartum respiratory morbidity, less breast-feeding and possibly more atopic disease. For society, caesarean section is more costly than vaginal delivery. INTERPRETATION There are many and complex causes of the rise in caesarean section rates in industrialized countries. The procedure has inherent negative consequences (short- and long-term) for mother and child, as well as being an economic burden to society. There is every reason to attempt prevention of a further increase in caesarean section rates.
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Broche DE, Ramanah R, Collin A, Mangin M, Vidal C, Maillet R, Riethmuller D. Présentation du siège à terme : facteurs prédictifs de césarienne en cours de travail. ACTA ACUST UNITED AC 2008; 37:483-92. [DOI: 10.1016/j.jgyn.2008.03.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2007] [Revised: 02/27/2008] [Accepted: 03/27/2008] [Indexed: 10/21/2022]
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Broche DE, Riethmuller D, Maticot-Baptista D, Ramanah R, Cossa S, Maillet R. Extraction par ventouse obstétricale sur présentation du siège décomplété. ACTA ACUST UNITED AC 2008; 37:143-8. [DOI: 10.1016/j.jgyn.2007.08.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2007] [Revised: 05/15/2007] [Accepted: 08/27/2007] [Indexed: 10/22/2022]
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Lagrange E, Ab der Halden M, Ughetto S, Boda C, Accoceberry M, Neyrat C, Houlle C, Vendittelli F, Laurichesse-Delmas H, Jacquetin B, Lémery D, Gallot D. Accouchement du siège par voie vaginale: évolution de l'acceptabilité par les obstétriciens et les patientes. ACTA ACUST UNITED AC 2007; 35:757-63. [PMID: 17707672 DOI: 10.1016/j.gyobfe.2007.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2007] [Accepted: 07/02/2007] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate the influence of obstetrician and patient respectively on mode of delivery in case of breech presentation at term. PATIENTS AND METHODS This retrospective study included all women with a singleton pregnancy in a breech presentation delivered at term in a tertiary care maternity unit from January 1998 to December 2004. Mode of delivery was suggested by a score based on maternal age, parity, obstetrical past history, radiopelvimetry and cephalopelvic confrontation. The obstetrician was free to follow or not the score indication and patient's informed consent was required concerning the mode of delivery. Our main outcome measurements were mode of delivery and neonatal parameters. RESULTS Two hundred cases were identified. Elective cesarean section increased progressively (from 52% in 1998 to 80% in 2004 [P=0,002]). Neonatal status and proportion of score in favour of vaginal birth remained stable during the study period. The rise in cesarean section rate was mainly due to patient's request (P=0,001) whereas the trend of obstetrician in favour of cesarean did not reach significance (P=0,3). DISCUSSION AND CONCLUSION The rise of elective cesarean section for term breech delivery in a maternity unit using a predefinite score is mainly induced by patient's request. This evolution has no effect on neonatal status.
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Affiliation(s)
- E Lagrange
- Pôle gynécologie-obstétrique-reproduction humaine, CHU de Clermont-Ferrand, Hôtel-Dieu, boulevard Léon-Malfreyt, 63003 Clermont-Ferrand, France
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Broche DE, Riethmuller D, Vidal C, Sautière JL, Schaal JP, Maillet R. Pronostic obstétrical et néonatal d’une présentation podalique de mauvaise réputation : le siège complet. ACTA ACUST UNITED AC 2005; 34:781-8. [PMID: 16319769 DOI: 10.1016/s0368-2315(05)82954-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES A nonfrank breech is generally believed to be associated with abnormal labor and risk of cord prolapse. Owing to these risks, many authors consider such a presentation as a positive indication for cesarean section. The purpose of this study was to estimate the delivery characteristics of nonfrank breech with a gestational age over 37 weeks and particularities of this presentation. PATIENTS AND METHODS This retrospective study included all deliveries with a nonfrank breech presentation and a gestational age over 37 weeks over a sixteen years period in our maternity ward. A descriptive analysis of maternal, fetal and obstetrical elements was carried out. RESULTS 198 deliveries were indexed with 54% vaginal birth, regularly observed throughout the study period. Thirty percent delivered by prelabor planned cesarean section and 16% by cesarean section during labor. When a vaginal birth trial was allowed, at last 77.4% delivered by this route. Average labor time in the vaginal birth group was only 4.5 hours. Eleven cord prolapses were found (5.6%) of which more than half delivered by vaginal birth without fetal complications. Perinatal outcomes were satisfactory for the whole population, without differences between cesarean section and vaginal birth. DISCUSSION Cord prolapse is a risk of nonfrank breech presentation but abnormal labor is not more frequent than with frank breech presentations if labor is managed rigorously. More than 75% patients of the vaginal birth trial group delivered by vaginal birth with perinatal outcomes as good as the cesarean section group. Unlike traditional reports, in our study a nonfrank breech was not an unfavorable factor for vaginal birth after strict selection of vaginal birth trial candidates.
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Affiliation(s)
- D-E Broche
- Clinique Universitaire de Gynécologie-Obstétrique, Besançon
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