Breech Presentation

Objective: To determine the outcome of external cephalic version in breech presentation and to analyze the perinatal and the maternal outcome.
Study Design: A prospective study was performed of 30 patients with breech presentation at 34 weeks or more period of gestation were enrolled. External Cephalic Version (ECV) was carried out in selected cases after applying inclusion and exclusion criteria at or after 37 weeks of gestation. These patients were followed up till the time of delivery for type of delivery, maternal and neonatal outcome. Data so accumulated was analyzed at the end of the study.
Results: Out of 30 attempted ECV 18 were successful out of which one reverted back to breech after initial successful external cephalic version. Total success rate of external cephalic version in the study was 60 percent (95% CI 43.3, 76.7) and failure rate was 40 percent (95% CI 23.3, 56.7). Of the total attempted ECV; 20 (66.7 %) were in nulliparous women, 08 (26.7 %) were in primiparous women and 02 (6.6 %) were in multiparous women. Total success rate in nulliparous women was 55 percent (11 out of 20), total success rate in primiparous women was 62.5 percent (5 out of 8) and all two cases of external cephalic version were successful in multiparous group. External cephalic version failure rates were 45 percent (9 out of 20) in nulliparous, and 37.5 percent (3 out of 8) in primiparous women respectively. There were no cases of failed external cephalic version in multiparous group.
Conclusion: External Cephalic Version is a cost effective, bed side and relatively safe procedure in experienced hands for doing so. Most of the cases of breech presentation are delivered by cesarean section in current obstetric practice. External cephalic version can be tried in selected cases before taking them up for cesarean section.

To compare breech outcomes when mothers delivering vaginally are upright, on their back, or planning cesareans. A retrospective cohort study was undertaken of all women who presented for singleton breech delivery at a center in Frankfurt, Germany, between January 2004 and June 2011. Of 750 women with term breech delivery, 315 (42.0%) planned and received a cesarean. Of 269 successful vaginal deliveries of neonates, 229 in the upright position were compared with 40 in the dorsal position. Upright deliveries were associated with significantly fewer delivery maneuvers (OR 0.45, 95% CI 0.31-0.68) and neonatal birth injuries (OR 0.08, 95% CI 0.01-0.58), second stages that were 42% shorter on average (1.02 vs 1.77 hours), and nonsignificantly decreased serious perineal lacerations (OR 0.34, 95% CI 0.05-3.99). When upright position was used almost exclusively, the cesarean rate decreased. Serious fetal and neonatal morbidity potentially related to birth mode was low, and similar for uprigh...

To assess the clinical factors that influence the estimates of clinicians of the success of an external cephalic version(ECV), and the subsequent management decisions made by clinicians. We constructed 16 fictional vignettes of women with a term fetus in breech position eligible for ECV. Setting. Secondary and tertiary clinics in The Netherlands. Thirty-seven gynaecologists, residents and midwifes. Sixteen case summaries concerning a hypothetical patient eligible for ECV. Potential prognostic factors that varied between the cases were parity, maternal body mass index, engagement of the fetus, amniotic fluid, fetal growth, fetal presentation and placental localisation. For each case presentation, the clinicians were asked for their inclination to perform an ECV, and whether or not they would use tocolysis. The estimated probabilities of success varied between 20 and 60%. The number of clinicians that would attempt an ECV varied per case between 32 and 97%. Amniotic fluid and engagement contributed 80% of the variation in the decision to perform ECV. In the case of oligohydramnios or an engaged breech, the clinicians tended not to perform an ECV. Amniotic fluid and engagement seem to be the main factors in the clinical decision-making of clinicians in ECV.This decision-making is probably experience based. Systematic knowledge of clinical prognosticators and subsequent assessment of their prognostic capacity is needed.

A 28-year-old, healthy pregnant patient developed bilateral pneumothorax, subcutaneous emphysema, pneumomediastinum, pneumoretroperitoneum and pneumoperitoneum following endotracheal intubation and manual ventilation during general anesthesia for breech extraction. It is likely that positive-pressure ventilation was the cause for this very rare combination of complications. Early recognition and treatment may prevent such a catastrophe.

The objective of this study was to compare pregnancy outcomes in women with fibromyomata who were treated with uterine artery embolization to the outcomes in women who were treated with laparoscopic myomectomy. We compiled data from 53 pregnancies after uterine artery embolization and 139 pregnancies after laparoscopic myomectomy. We calculated and compared rates for spontaneous abortion, postpartum hemorrhage, preterm delivery, cesarean delivery, small for gestational age, and malpresentation. Pregnancies after uterine artery embolization had higher rates of preterm delivery (odds ratio, 6.2; 95% CI, 1.4, 27.7) and malpresentation (odds ratio, 4.3; 95% CI, 1.0, 20.5) than did pregnancies after laparoscopic myomectomy. The risks of postpartum hemorrhage (odds ratio, 6.3; 95% CI, 0.6, 71.8) and spontaneous abortion (odds ratio, 1.7; 95% CI, 0.8, 3.9) after uterine artery embolization were similarly higher than the risks after laparoscopic myomectomy; however, these differences were not statistically significant. Pregnancies in women with fibromyomata who were treated by uterine artery embolization, compared with pregnancies after laparoscopic myomectomy, were at increased risk for preterm delivery and malpresentation.

We report a case of an otherwise healthy neonate diagnosed at birth with a classic metaphyseal lesion of the proximal tibia following external cephalic version for frank breech presentation and a subsequent urgent cesarean section. Although the classic metaphyseal lesion is considered highly specific for infant abuse, this case demonstrates the importance of obtaining a history of obstetric trauma for neonates presenting to the imaging department for suspected non-accidental injury.

Uterine artery embolization is an increasingly popular alternative to hysterectomy and myomectomy as a treatment for uterine leiomyoma. Whether this procedure is safe for women desiring future fertility is controversial. A primigravida who had previously undergone uterine artery embolization had premature rupture of membranes at 24 weeks. She had a cesarean delivery at 28 weeks, which was followed by uterine atony requiring hysterectomy. A primigravida who had previously undergone uterine artery embolization delivered appropriately grown dichorionic twins at 36 weeks. An analysis of the 50 published cases of pregnancy after uterine artery embolization revealed the following complications: malpresentation (17%), small for gestational age (7%), premature delivery (28%), cesarean delivery (58%), and postpartum hemorrhage (13%). Women who become pregnant after uterine artery embolization are at risk for malpresentation, preterm birth, cesarean delivery, and postpartum hemorrhage.

The safety, efficacy, and cost-effectiveness of external cephalic version (ECV) for term breech presentation has been demonstrated. Clinical guidelines recommend ECV for all eligible women, but the uptake of this procedure in the Australian healthcare setting is unknown. This study aimed to describe ECV uptake in New South Wales, the most populous state of Australia, during 2002 to 2012. Data from routine hospital and birth records were used to identify ECVs conducted at ≥36 weeks' gestation. Women with ECV were compared to women who were potentially eligible for but did not have ECV. Eligibility for ECV was based on clinical guidelines. For those with ECV, birth outcomes following successful and unsuccessful procedures were examined. In N = 32,321 singleton breech pregnancies, 10.5% had ECV, 22.3% were ineligible, and 67.2% were potentially eligible but did not undergo ECV. Compared to women who were eligible but who did not attempt ECV, those who had ECV were more likely to be...

Objective To review the short and long term outcomes among singleton infants with breech presentation at term delivered in a geographically defined population over a 10-year period. Design Retrospective, cohort study. Setting District General Hospital. Population 1433 term ...

To evaluate the preferred types of uterine closure at Caesarean section among Quebec's obstetrician-gynaecologists. An anonymous survey with multiple-choice and open questions was sent by email to all members of the Association des Obstétriciens-Gynécologues du Québec in clinical practice. The primary response of interest was the type of uterine closure that would be favoured for a primigravida undergoing an elective CS at term for a breech fetus. Secondary responses of interest included type of uterine closure for CS performed for other indications, and methods of closure for the bladder flap, parietal peritoneum, rectus abdominis muscle, subcutaneous tissue, and skin. Results were stratified according to the number of years in practice. Of 454 persons targeted, 176 (39%) responded. Responders were more likely to have fewer years in practice than the targeted population in general. The closures for a primigravida undergoing an elective CS at term for a breech presentation were,...