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Yaouzis Olsson N, Bartfai ED, Åmark H, Wallström T. Outcomes in term breech birth according to intended mode of delivery-A Swedish prospective single-center experience of a dedicated breech birth team. Acta Obstet Gynecol Scand 2024. [PMID: 39129446 DOI: 10.1111/aogs.14945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 07/22/2024] [Accepted: 07/24/2024] [Indexed: 08/13/2024]
Abstract
INTRODUCTION The appropriate mode of delivery for breech babies is a topic of ongoing debate. After the publication of the Term Breech Trial in 2000, the proportion of breech babies delivered vaginally in Sweden rapidly dropped to 7% from 26%. In 2015, international guidelines changed to once again recommend offering vaginal breech deliveries in select cases. In 2017, a Swedish hospital established a dedicated Breech Team to provide safe vaginal breech deliveries according to the new guidelines. The aim of this study is to compare neonatal morbidity in the group planned for cesarean breech delivery with the group planned for vaginal breech delivery treated in accordance with the new guidelines. The study adds to the literature by providing insights into the consequences of reintroducing vaginal breech births in a high-resource health-care setting. MATERIAL AND METHODS A prospective observational study was conducted at Södersjukhuset's maternity ward with 1067 women who gave birth to a single breech fetus at term. Outcomes were compared between the planned vaginal and planned cesarean delivery groups using intention-to-treat analysis and multivariate analysis to control for confounders. RESULTS Out of the 1067 women, 78.9% were planned for cesarean delivery and 21.1% were planned for vaginal delivery. The planned vaginal group had a significantly greater risk for neonatal morbidity compared to the planned cesarean group (3.1% vs. 0.7%; OR 4.44, 95% CI 1.48-13.34). The risk difference remained significant after controlling for confounders. CONCLUSIONS Planned vaginal breech delivery was associated with an increased risk of neonatal mortality and short-term morbidity compared to planned cesarean breech delivery in accordance with the new guidelines. The potential risks and benefits of planned vaginal breech delivery should be carefully weighed against those of planned cesarean delivery.
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Affiliation(s)
- Nicolas Yaouzis Olsson
- Department of Clinical Science and Education, Unit of Obstetrics and Gynecology, Karolinska Institutet, Stockholm, Sweden
| | - Emma Debora Bartfai
- Department of Clinical Science and Education, Unit of Obstetrics and Gynecology, Karolinska Institutet, Stockholm, Sweden
| | - Hanna Åmark
- Department of Clinical Science and Education, Unit of Obstetrics and Gynecology, Karolinska Institutet, Stockholm, Sweden
| | - Tove Wallström
- Department of Clinical Science and Education, Unit of Obstetrics and Gynecology, Karolinska Institutet, Stockholm, Sweden
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Dasgupta T, Hunter S, Reid S, Sandall J, Shennan A, Davies SM, Walker S. Breech specialist midwives and clinics in the OptiBreech Trial feasibility study: An implementation process evaluation. Birth 2023; 50:596-605. [PMID: 36288483 DOI: 10.1111/birt.12685] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 08/03/2022] [Accepted: 10/06/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Attendance of skilled and experienced professionals at breech births has been associated with a reduction in adverse perinatal outcomes. We aimed to determine whether United Kingdom National Health Service (NHS) sites could reliably provide attendants with OptiBreech training and/or advanced proficiency (intervention feasibility) and consistent care (fidelity) that meets women's needs (acceptability), with low neonatal admission rates (safety) and recruitment adequate to support a clinical trial (trial feasibility). METHODS Mixed methods implementation evaluation was used. Settings were 13 services in England and Wales. Participants were 82 women requesting support for a vaginal breech birth (VBB) at term. Outcomes were descriptively analyzed. Twenty-one women were interviewed, and transcripts were analyzed using the Theoretical Framework of Acceptability. Iterative analysis informed subsequent interviews and the ongoing process of implementation across sites. RESULTS Although we initially suggested multidisciplinary teams, actively recruiting Trusts yielded services where VBB care was provided through a dedicated clinic, organized and delivered primarily by a lead midwife who functioned as a specialist. This model achieved 87.5% fidelity with the intervention's goal of ensuring the attendance of OptiBreech-trained professionals. Neonatal outcomes remained stable, with an admission rate of 5.5%. Women reported care from specialist midwives as highly acceptable, but the model is vulnerable without a strategic effort to develop additional proficient team members. CONCLUSIONS Dedicated clinics coordinated by specialist midwives appear to be an acceptable and feasible implementation strategy to test the safety and effectiveness of proficient team care for VBB in a clinical trial. Back-up arrangements should be maintained while additional members of the team develop proficiency.
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Affiliation(s)
- Tisha Dasgupta
- Department of Women & Children's Health, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Sarah Hunter
- Department of Women & Children's Health, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
- Independent Lay Members of the Research Team, Peterborough, UK
| | - Sharna Reid
- Department of Women & Children's Health, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
- Independent Lay Members of the Research Team, London, UK
| | - Jane Sandall
- Department of Women & Children's Health, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Andrew Shennan
- Department of Women & Children's Health, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Siân M Davies
- Department of Women & Children's Health, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Shawn Walker
- Department of Women & Children's Health, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
- Chelsea and Westminster Hospital NHS Foundation Trust, Women's and Children's Services, London, UK
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Tavares VB, E Souza JDS, Affonso MVDG, Da Rocha ES, Rodrigues LFG, da Costa Moraes LDF, Dos Santos Coelho GC, Araújo SS, das Neves PFM, Gomes FDC, de Melo-Neto JS. Factors associated with 5-min APGAR score, death and survival in neonatal intensive care: a case-control study. BMC Pediatr 2022; 22:560. [PMID: 36151512 PMCID: PMC9502588 DOI: 10.1186/s12887-022-03592-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 08/29/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The 5-minute APGAR score is clinically used as a screening tool to assess how the newborn has reacted to previous care, remaining relevant for predicting neonatal survival. This study aimed to analyze the determinants of the 5th minute APGAR score, and the factors associated with the death and survival of newborns with low APGAR scores hospitalized in the neonatal intensive care unit (NICU) at a referral public hospital in North Brazil. METHODS This was a hospital-based retrospective case-control study with 277 medical records. Newborns who presented with a 1-minute APGAR score < 7 followed by a 5-minute APGAR score < 7 were considered cases, while a score ≥ 7 was categorized as controls. Univariate and multivariable logistic regression analyses were used to establish the determinant factors of the low APGAR score and death outcome in this group. Survival curves were obtained using the Kaplan-Meier estimator, and then univariate and multivariate Cox regression was performed. RESULTS After adjusted analysis, the factor associated with low APGAR scores was vaginal delivery (OR = 3.25, 95%CI = 1.60-6.62, p = 0.001). Birth injury (OR = 0.39, 95%CI = 0.19-0.83, p = 0.014) was associated with upper APGAR scores. No significant independent associations were observed between the variables analyzed and death in the low APGAR score group. The Kaplan-Meier curve showed that individuals who presented Cesarean delivery had a shorter survival time in the ICU. CONCLUSION In this setting, a 5-minute Apgar score < 7 was associated with the occurrence of vaginal delivery and birth injury with a 5-minute Apgar score ≥ 7. Survival in ICU was lower in newborns that were delivered via cesarean section.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - João Simão de Melo-Neto
- Federal University of Pará (UFPA), Belém, PA, Brazil.
- Clinical and Experimental Research Unit of the Urogenital System (UPCEURG), Institute of Health Sciences of the Federal University of Pará. João de Barros Barreto Hospital, Mundurucus street, 4487; Guamá, Belém, PA, CEP: 66073-000, Brazil.
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Leow HW, Tan EL, Black M. Reported outcomes for planned caesarean section versus planned vaginal delivery: A systematic review. Eur J Obstet Gynecol Reprod Biol 2020; 256:101-108. [PMID: 33197678 DOI: 10.1016/j.ejogrb.2020.10.057] [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: 06/22/2020] [Revised: 10/16/2020] [Accepted: 10/23/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is currently no consensus regarding the outcomes and outcome measures that should be reported in studies assessing planned mode of birth. OBJECTIVE To develop an inventory for reported outcomes for studies comparing planned caesarean section (CS) and planned vaginal delivery (VD) for women age 18-45. METHODS A systematic review of outcomes reported in prospective studies investigating planned CS and planned VD was conducted. Three online databases, Ovid SP version of MEDLINE and EMBASE and the Cochrane Pregnancy and Childbirth Group's Trials Register, were searched from 2011 to June 2019. The inclusion criteria were: prospective studies evaluating planned mode of birth, age 18-45, singleton pregnancy, gestational age 37-40 weeks, >100 participants, middle or high income countries. No language restrictions were applied. Two researchers independently screened titles and abstracts, and subsequently reviewed the full text of each selected study to assess for eligibility. Discrepancies were resolved by discussion with a third author. The selected studies were evaluated using the MOMENT criteria. Outcomes and outcome measures were systematically extracted and organised into an inventory. RESULTS 63 prospective studies comparing planned CS versus planned VD including data from 6,397,310 women were included. 37 studies (59%) investigating planned CS versus planned VD fulfilled four or more MOMENT criteria. In total, 43 different primary outcomes and 79 different primary outcome measures, and 12 different secondary outcomes and 31 secondary outcome measures were identified from studies investigating planned CS versus planned VD. CONCLUSION The findings of this study will contribute to the development of a core outcome set for planned mode of birth in the future. Standardising outcomes will aid comparison and interpretation of data pertaining to planned CS versus planned VD. PROSPERO registration: CRD42019133104.
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Affiliation(s)
- Hui Wei Leow
- University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, United Kingdom.
| | - Elizabeth Lilinn Tan
- University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, United Kingdom
| | - Mairead Black
- University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, United Kingdom
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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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Genuttis N, Bolz M, Briese V. Can the Rate of C-sections Performed in a Level I Perinatal Center Be Reduced? - An Analysis of the University Gynecology Clinic Rostock, 2008 - 2014. Geburtshilfe Frauenheilkd 2017; 77:771-779. [PMID: 28757656 PMCID: PMC5514020 DOI: 10.1055/s-0043-112863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 04/23/2017] [Accepted: 06/01/2017] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION In Germany the rate of deliveries by cesarean section is continually increasing. Many different reasons have been put forward to explain this trend. The aim of this study was to examine how the C-section rate developed at the University Gynecology Clinic Rostock, one of the biggest maternity hospitals and level I perinatal centers in Germany, based on various maternal and neonatal parameters. The aim was also to identify potential risk factors for C-sections. MATERIAL AND METHOD Various obstetric parameters were obtained from the birth cohort (2008 to 2014; n = 20 091) of the University Gynecology Clinic Rostock. The data was used to calculate parameter-specific C-section rates. Potential risk factors for C-section were identified by regression analysis. RESULTS The C-section rate dropped from 26.24% to 23.57%. The rate of repeat C-sections also declined. The mean age of the pregnant women increased. Nevertheless, the frequency of cesarean sections in pregnant women aged more than 35 years declined. Rates of being overweight or obese preconception increased. C-section rates increased as BMI values preconception increased. There was a perceptible trend towards attempting the vaginal delivery of children in breech presentation and of twins. The frequency of depressed neonates after vaginal delivery and after C-section decreased. Rates for mild and advanced acidosis increased after both C-sections and vaginal deliveries. Previous C-section, older maternal age, overweight and obesity prior to conception, breech presentation and multiple pregnancies all increased the risk of cesarean sections. CONCLUSION This study showed that reducing the rates of C-sections without a deterioration in neonatal outcomes can be achieved even in a large maternity hospital that cares for many high-risk pregnancies.
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Affiliation(s)
- Nele Genuttis
- Universitätsfrauenklinik Rostock, Klinikum Südstadt Rostock, Rostock, Germany
| | - Michael Bolz
- Universitätsfrauenklinik Rostock, Klinikum Südstadt Rostock, Rostock, Germany
| | - Volker Briese
- Universitätsfrauenklinik Rostock, Klinikum Südstadt Rostock, Rostock, Germany
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Walker S, Breslin E, Scamell M, Parker P. Effectiveness of vaginal breech birth training strategies: An integrative review of the literature. Birth 2017; 44:101-109. [PMID: 28211102 DOI: 10.1111/birt.12280] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 01/12/2017] [Accepted: 01/12/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND The safety of vaginal breech birth depends on the skill of the attendant. The objective of this review was to identify, synthesize, and report the findings of evaluated breech birth training strategies. METHODS A systematic search of the following on-line databases: Medline, CINAHL Plus, PsychINFO, EBM Reviews/Cochrane Library, EMBASE, Maternity and Infant Care, and Pubmed, using a structured search strategy. Studies were included in the review if they evaluated the efficacy of a breech birth training program or particular strategies, including obstetric emergency training evaluations that reported differentiated outcomes for breech. Out of 1040 original citings, 303 full-text articles were assessed for eligibility, and 17 methodologically diverse studies met the inclusion criteria. A data collection form was used to extract relevant information. Data were synthesized, using an evaluation levels framework, including reaction, learning (subjective and objective assessment), and behavioral change. RESULTS No evaluations included clinical outcome data. Improvements in self-assessed skill and confidence were not associated with improvements in objective assessments or behavioral change. Inclusion of breech birth as part of an obstetric emergencies training package without support in practice was negatively associated with subsequent attendance at vaginal breech births. CONCLUSIONS As a result of the heterogeneity of the studies available, and the lack of evidence concerning neonatal or maternal outcomes, no conclusive practice recommendations can be made. However, the studies reviewed suggest that vaginal breech birth training may be enhanced by reflection, repetition, and experienced clinical support in practice. Further evaluation studies should prioritize clinical outcome data.
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Affiliation(s)
- Shawn Walker
- Centre for Maternal and Child Health Research, City, University of London, London, UK
| | - Eamonn Breslin
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Mandie Scamell
- Centre for Maternal and Child Health Research, City, University of London, London, UK
| | - Pam Parker
- Department for Learning Enhancement and Development, City, University of London, London, UK
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Macharey G, Gissler M, Rahkonen L, Ulander VM, Väisänen-Tommiska M, Nuutila M, Heinonen S. Breech presentation at term and associated obstetric risks factors-a nationwide population based cohort study. Arch Gynecol Obstet 2017; 295:833-838. [PMID: 28176014 DOI: 10.1007/s00404-016-4283-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 12/22/2016] [Indexed: 01/21/2023]
Abstract
PURPOSE The aim of this study was to estimate whether breech presentation at term was associated with known individual obstetric risk factors for adverse fetal outcome. METHODS This was a retrospective, nationwide Finnish population-based cohort study. Obstetric risks in all breech and vertex singleton deliveries at term were compared between the years 2005 and 2014. A multivariable logistic regression model was used to determine significant risk factors. RESULTS The breech presentation rate at term for singleton pregnancies was 2.4%. The stillbirth rate in term breech presentation was significantly higher compared to cephalic presentation (0.2 vs 0.1%). The odds ratios (95% CIs) for fetal growth restriction, oligohydramnios, gestational diabetes, a history of cesarean section and congenital fetal abnormalities were 1.19 CI (1.07-1.32), 1.42 CI (1.27-1.57), 1.06 CI (1.00-1.13), 2.13 (1.98-2.29) and 2.01 CI (1.92-2.11). CONCLUSIONS The study showed that breech presentation at term on its own was significantly associated with antenatal stillbirth and a number of individual obstetric risk factors for adverse perinatal outcomes. The risk factors included oligohydramnios, fetal growth restriction, gestational diabetes, history of caesarean section and congenital anomalies.
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Affiliation(s)
- Georg Macharey
- Department of Obstetrics and Gynecology, Helsinki University Hospital (HUS), University of Helsinki, Haartmaninkatu 2, 00290, Helsinki, Finland.
| | - Mika Gissler
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Leena Rahkonen
- Department of Obstetrics and Gynecology, Helsinki University Hospital (HUS), University of Helsinki, Haartmaninkatu 2, 00290, Helsinki, Finland
| | - Veli-Matti Ulander
- Department of Obstetrics and Gynecology, Helsinki University Hospital (HUS), University of Helsinki, Haartmaninkatu 2, 00290, Helsinki, Finland
| | - Mervi Väisänen-Tommiska
- Department of Obstetrics and Gynecology, Helsinki University Hospital (HUS), University of Helsinki, Haartmaninkatu 2, 00290, Helsinki, Finland
| | - Mika Nuutila
- Department of Obstetrics and Gynecology, Helsinki University Hospital (HUS), University of Helsinki, Haartmaninkatu 2, 00290, Helsinki, Finland
| | - Seppo Heinonen
- Department of Obstetrics and Gynecology, Helsinki University Hospital (HUS), University of Helsinki, Haartmaninkatu 2, 00290, Helsinki, Finland
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Lai S, Flatley C, Kumar S. Perinatal risk factors for low and moderate five-minute Apgar scores at term. Eur J Obstet Gynecol Reprod Biol 2017; 210:251-256. [PMID: 28076828 DOI: 10.1016/j.ejogrb.2017.01.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 12/23/2016] [Accepted: 01/04/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate the specific maternal and perinatal variables associated with a low (≤3) or moderate (4-6) Apgar score, compared to a high (≥7) score. STUDY DESIGN This was a retrospective, cohort study of 58429 term singleton babies born at the Mater Mother's Hospital in Brisbane, Australia in 2007-2013. Maternal demographics, socio-economic status using the Australian Socioeconomic Index for Areas (SEIFA) score, obstetric factors, and birth outcomes were compared for neonates grouped into three categories based on their five-minute Apgar: low (≤3), moderate (4-6) and high (≥7). The low- and moderate-score cohorts were individually compared to the high-score cohort using both univariate and multivariate analysis. RESULTS Logistic regression analysis confirmed that of the variables analysed, only maternal public insurance status (OR 2.1, 95% CI 1.5-3.1), breech presentation (OR 2.4, 95% CI 1.1-4.6), other non-cephalic presentation (OR 9.5, 95% CI 2.2-25.4), intramuscular narcotic use (OR 2.3, 95% CI 1.5-3.5), and presence of meconium (OR 3.7, 95% CI 2.5-5.4) were significantly associated with low Apgar scores. Variables significantly associated with a moderate score were: SEIFA ≤50th centile (OR 1.6, 95% CI 1.2-2.0) and 61st to 70th centile (OR 1.31, 95% CI 0.9-1.8) categories, maternal public insurance status (OR 2.7, 95% CI 2.2-3.3), nulliparity (OR 2.0, 95% CI 1.7-2.5), emergency caesarean birth (OR 2.6, 95% CI 2.1-3.2), instrumental birth (OR 2.3, 95% CI 1.9-2.9), and presence of meconium (OR 2.6, 95% CI 2.1-3.2). CONCLUSIONS Factors associated with low and moderate Apgar scores vary in type and degree of influence. Distinctions in the perinatal background can help predict newborn compromise and accelerate delivery of care.
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Affiliation(s)
- Shimona Lai
- Mater Research Institute - University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, Queensland, QLD 4101, Australia
| | - Christopher Flatley
- Mater Research Institute - University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, Queensland, QLD 4101, Australia
| | - Sailesh Kumar
- Mater Research Institute - University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, Queensland, QLD 4101, Australia; School of Medicine, The University of Queensland, Brisbane, Australia.
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‘Stress, anger, fear and injustice’: An international qualitative survey of women's experiences planning a vaginal breech birth. Midwifery 2017; 44:41-47. [DOI: 10.1016/j.midw.2016.11.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 10/09/2016] [Accepted: 11/20/2016] [Indexed: 11/24/2022]
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Catling C, Petrovska K, Watts N, Bisits A, Homer C. Barriers and facilitators for vaginal breech births in Australia: Clinician's experiences. Women Birth 2016; 29:138-43. [DOI: 10.1016/j.wombi.2015.09.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 09/14/2015] [Accepted: 09/21/2015] [Indexed: 11/27/2022]
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12
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Catling C, Petrovska K, Watts N, Bisits A, Homer C. Care during the decision-making phase for women who want a vaginal breech birth: Experiences from the field. Midwifery 2016; 34:111-116. [DOI: 10.1016/j.midw.2015.12.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 12/09/2015] [Accepted: 12/20/2015] [Indexed: 10/22/2022]
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Walker S, Scamell M, Parker P. Standards for maternity care professionals attending planned upright breech births: A Delphi study. Midwifery 2016; 34:7-14. [DOI: 10.1016/j.midw.2016.01.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 01/14/2016] [Accepted: 01/18/2016] [Indexed: 10/22/2022]
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Secter MB, Simpson AN, Gurau D, Snelgrove JW, Hodges R, Mocarski E, Pittini R, Windrim R, Higgins M. Learning From Experience: Qualitative Analysis to Develop a Cognitive Task List for Vaginal Breech Deliveries. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2015; 37:966-74. [DOI: 10.1016/s1701-2163(16)30046-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Vistad I, Klungsøyr K, Albrechtsen S, Skjeldestad FE. Neonatal outcome of singleton term breech deliveries in Norway from 1991 to 2011. Acta Obstet Gynecol Scand 2015; 94:997-1004. [DOI: 10.1111/aogs.12684] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 05/22/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Ingvild Vistad
- Department of Obstetrics and Gynecology; Sorlandet Hospital HF; Kristiansand Norway
| | - Kari Klungsøyr
- Department of Global Public Health and Primary Care; University of Bergen; Bergen Norway
- Medical Birth Registry of Norway; Norwegian Institute of Public Health; Bergen Norway
| | - Susanne Albrechtsen
- Department of Obstetrics and Gynecology; Haukeland University Hospital; Bergen Norway
- Department of Clinical Medicine; University of Bergen; Bergen Norway
| | - Finn E. Skjeldestad
- Faculty of Health Sciences; Department of Community Medicine; Research Group Epidemiology of Chronic Diseases; UiT; the Arctic University of Norway; Tromsø Norway
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Homer CS, Watts NP, Petrovska K, Sjostedt CM, Bisits A. Women's experiences of planning a vaginal breech birth in Australia. BMC Pregnancy Childbirth 2015; 15:89. [PMID: 25885035 PMCID: PMC4396595 DOI: 10.1186/s12884-015-0521-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 03/30/2015] [Indexed: 11/10/2022] Open
Abstract
Background In many countries, planned vaginal breech birth (VBB) is a rare event. After the Term Breech Trial in 2000, VBB reduced and caesarean section for breech presentation increased. Despite this, women still request VBB. The objective of this study was to explore the experiences and decision-making processes of women who had sought a VBB. Methods A qualitative study using descriptive exploratory design was undertaken. Twenty-two (n = 22) women who planned a VBB, regardless of eventual mode of birth were recruited. The women had given birth at one of two maternity hospitals in Australia that supported VBB. In-depth, semi-structured interviews using an interview guide were conducted. Interviews were analysed thematically. Results Twenty two women were interviewed; three quarters were primiparous (n = 16; 73%). Nine (41%) were already attending a hospital that supported VBB with the remaining women moving hospitals. All women actively sought a vaginal breech birth because the baby remained breech after an external cephalic version – 12 had a vaginal birth (55%) and 10 (45%) a caesarean section after labour commenced. There were four main themes: Reacting to a loss of choice and control, Wanting information that was trustworthy, Fighting the system and seeking support for VBB and The importance of ‘having a go’ at VBB. Conclusions Women seeking a VBB value clear, consistent and relevant information in deciding about mode of birth. Women desire autonomy to choose vaginal breech birth and to be supported in their choice with high quality care.
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Affiliation(s)
- Caroline Se Homer
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Level 7, 235 Jones St, Ultimo NSW 2007, PO Box 123, Sydney, Australia.
| | - Nicole P Watts
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Level 7, 235 Jones St, Ultimo NSW 2007, PO Box 123, Sydney, Australia.
| | - Karolina Petrovska
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Level 7, 235 Jones St, Ultimo NSW 2007, PO Box 123, Sydney, Australia.
| | - Chauncey M Sjostedt
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Level 7, 235 Jones St, Ultimo NSW 2007, PO Box 123, Sydney, Australia.
| | - Andrew Bisits
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Level 7, 235 Jones St, Ultimo NSW 2007, PO Box 123, Sydney, Australia. .,Royal Hospital for Women, Barker St, Randwick, NSW 2031, Australia.
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Sharoni L, Weiniger CF. Anesthesia and External Cephalic Version. CURRENT ANESTHESIOLOGY REPORTS 2015. [DOI: 10.1007/s40140-014-0095-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Maier B. Is the narrow concept of individual autonomy compatible with or in conflict with Evidence-based Medicine in obstetric practice? ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.woman.2014.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Toivonen E, Palomäki O, Huhtala H, Uotila J. Maternal experiences of vaginal breech delivery. Birth 2014; 41:316-22. [PMID: 24935907 DOI: 10.1111/birt.12119] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/09/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND The optimal mode of breech birth remains controversial. In Finland, a trial of vaginal delivery is possible if strict selection criteria are met. As clinical practice in managing vaginal breech birth differs from that in normal delivery, the birth experience may also be different. This cohort study compares the childbirth experience between term breech and vertex deliveries. METHODS Intended vaginal term breech births from 2008 to October 2012 were included, and for every breech delivery, a vertex control was selected. The proportions of deliveries ending in a cesarean section and of mothers who had given birth vaginally before were equal in both groups. Three hundred eight mothers were sent the childbirth experience questionnaire and 170 returned it. RESULTS The birth experience does not differ between breech and vertex births, except for aspects with respect to the choice of birthing position. Indications of an even more positive experience were observed in the breech group, with the exception of the choice of analgesia, but these were not statistically significant. Primiparity, emergency cesarean section, infant birth trauma and prolonged hospital stay were identified as risk factors for a negative birth experience. CONCLUSION The birth experience of vaginal breech birth seems to be at least as positive as the vaginal vertex birth experience.
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Affiliation(s)
- Elli Toivonen
- School of Medicine, University of Tampere, Tampere, Finland
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Comparison of fetal outcome in premature vaginal or cesarean breech delivery at 24-37 gestational weeks. Arch Gynecol Obstet 2014; 290:271-81. [PMID: 24668252 DOI: 10.1007/s00404-014-3203-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 02/28/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To compare the fetal outcome of preterm breech infants delivered vaginally (VD) or by cesarean section (CS). METHODS A monocentric, retrospective consecutive case series of preterm breech deliveries between 24-37 gestational weeks over 10 years from 1/2000 to 12/2009 was performed in a perinatal care center (Level 1) at the University Clinic of Salzburg, Austria. Data from hospital database were statistically analyzed and compared regarding birth weight, head circumference, parity, transfer rate to neonatal intensive care unit (NICU), arterial and venous cord blood pH and base excess (BE), arterial cord blood pH ≤ 7.10 and BE ≤ -11. Special focus was on fetal outcome of elective CS preterm breech deliveries with a non-urgent medical indication compared to VD. RESULTS Among 22.115 deliveries, there were 346 live-born preterm singletons and twins in breech presentation (1.56 %), born between 24 + 0 and 37 + 0 gestational weeks. 180 CS and 36 vaginally delivered preterm breech infants were statistically evaluated. On comparing CS vs. VD for premature breech singletons, arterial cord blood pH and BE were lower in the VD group. VD twins had a lower arterial cord blood pH than CS twins. All other parameters were comparable. In preterm breech singletons with non-urgent CS, a statistical analysis was not possible due to small numbers. The VD twin group revealed lower values in birth weight, head circumference, arterial cord blood pH and BE, but no significant difference in venous cord blood pH and BE and transfer rate to NICU. CONCLUSIONS Although general recommendations regarding a superior mode of delivery for improved fetal outcome of preterm breech infants cannot be given, these data do not support a policy of routine CS.
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Glezerman M. Planned vaginal breech delivery: current status and the need to reconsider. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/eog.12.2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Patient satisfaction with childbirth after external cephalic version. Arch Gynecol Obstet 2013; 289:523-31. [DOI: 10.1007/s00404-013-3007-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Accepted: 08/07/2013] [Indexed: 11/26/2022]
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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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Assunção Salustiano EM, DuarteBonini Campos JA, Ibidi SM, Ruano R, Zugaib M. Low Apgar scores at 5 minutes in a low risk population: Maternal and obstetrical factors and postnatal outcome. Rev Assoc Med Bras (1992) 2012. [DOI: 10.1590/s0104-42302012000500017] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Low Apgar scores at 5 minutes in a low risk population: Maternal and obstetrical factors and postnatal outcome. Rev Assoc Med Bras (1992) 2012. [DOI: 10.1016/s0104-4230(12)70254-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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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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