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Breech Presentation (breech + presentation)

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Medical Sciences	100%

Selected Abstracts

Term breech singletons and caesarean section: A population study, Australia 1991,2005

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 5 2009
Elizabeth Anne SULLIVAN
Objective: To describe the method of birth of term breech singletons in Australia. Design, setting and participants: A retrospective population-based study of women who gave birth to term breech singletons in Australia between 1 January 1991 and 31 December 2005 using data from the National Perinatal Data Collection. Main outcome measures: Caesarean section, vaginal breech birth. Results:, Method of birth changed for term breech singletons from 1991 (vaginal breech birth 23.1% versus caesarean (no labour 55.6%, labour 21.2%)) to 2005 (vaginal breech birth 3.7% versus caesarean (no labour 76.6%, labour 19.7%)). Overall, the population attributable risk percentage of term breech singletons for all caesarean sections declined from 10.2% in 1991 to 6.9% in 2005. Conclusion:, Planned caesarean section is the standard method of birth for term breech singletons in Australia. Active measures including external cephalic version should be supported to reduce the rate of caesarean section where clinically indicated. Retention of a skilled clinical workforce is essential in the provision of the latter and to assist the minority of women having vaginal breech births. Breech presentation is not a major factor in the overall rise in caesarean section experienced by Australia since 1996. [source]

Effect of Managed Care Enrollment on Primary and Repeat Cesarean Rates Among U.S. Department of Defense Health Care Beneficiaries in Military and Civilian Hospitals Worldwide, 1999,2002

BIRTH, Issue 4 2004
Andrea Linton MS
However, little conclusive evidence exists to support this solution. We undertook a study of the Department of Defense health care beneficiary population to assess the impact of enrollment in TRICARE Prime, the Department's managed care health plan, on cesarean delivery rates. Methods: Pooled hospital discharge records from 1999,2002 for live, singleton births were analyzed to calculate primary and repeat cesarean rates for TRICARE Prime and non-Prime beneficiaries in the military and civilian hospitals that comprise the Department of Defense health care network. Stepwise logistic regression was used to calculate adjusted odds ratios for clinical indicators for each combination of health plan and hospital setting using the,2difference(p < 0.05)to eliminate nonsignificant variables from the model. Total primary and repeat cesarean rates were compared with primary and repeat cesarean rates for women with no reported clinical complications to account for differences in case mix across subgroups. Statistical significance of the differences calculated for subgroups was assessed using,2. Results: Primary cesarean rates were significantly lower for TRICARE Prime enrollees relative to non-Prime beneficiaries for all race subgroups and three of five age subgroups in military hospitals and four of five age subgroups in civilian hospitals. No significant differences in repeat cesarean rates were observed between Prime and non-Prime beneficiaries within any race or age subgroup. Breech presentation followed by dystocia, fetal distress, and other complications were significant predictors for primary cesarean. Previous cesarean delivery was the leading predictor for repeat cesarean delivery. Primary and repeat cesarean rates observed for military hospitals were consistently lower than rates observed for civilian hospitals within each health plan type and age group. Conclusions: Enrollment in the managed care health plan was significantly associated with lower risk of primary cesarean delivery relative to membership in other health plans offered to Department of Defense health care beneficiaries. Repeat cesarean rates in this population varied independently of health plan type. Primary cesarean delivery was generally associated with clinical complications, whereas previous cesarean delivery was the strongest indictor for a repeat cesarean delivery. A clear explanation of reduced cesarean rates for Prime enrollees remains elusive, but it is likely that factors beyond individual practitioner decision-making were at work. [source]

Adolescent primiparas: Changes in obstetrical risk between 1983,1987 and 1999,2005

JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 2 2008
Willibald Zeck
Abstract Aims:, Teenage pregnancies have always been considered at increased risk for obstetric complications. Deliveries in adolescent primiparas in the 5-year time periods 1983,1987 and 1999,2005 were compared against each other, the general population and against primiparas aged 20,29 years in order to reveal trends and differences in obstetric outcome. Methods:, A total of 186 primiparas delivering at an age of 17 or less between October 1999 and October 2005 were compared with 353 adolescent primiparas delivered between 1983 and 1987. Type of delivery and complications such as low birthweight, pre-eclampsia, breech presentation and third stage complications were studied. Results:, The percentage of adolescents in the overall obstetric population decreased. The cesarean section rate remained the same in the adolescents while increasing in the general population. Rates of low birthweight and operative vaginal delivery increased in the adolescent group and overall. Third stage complications (abnormally adherent or incomplete placentas) decreased in both groups. There were no intrauterine fetal deaths in adolescent pregnancies in either time period. Other obstetric variables were unchanged in the adolescent as well as in the general population between 1999 and 2005. When comparing the adolescents' outcome with the outcome of the 20,29-year-old primiparas between 1999 and 2005, it was noted that the rates of abstracted obstetric variables were higher in the population of the 20,29-year-olds. Conclusions:, The obstetric outcome of adolescent pregnancies has remained favorable over the last 18 years. We do not consider adolescence as an obstetrical risk. We suggest that adolescent pregnancy is more a public health issue than a clinical problem. [source]

Neonatal onychomadesis with candidiasis limited to affected nails

PEDIATRIC DERMATOLOGY, Issue 6 2008
NISHA C. PATEL M.D.
We hypothesize that the nail deformities were induced by the stress of a breech presentation during preterm labor and that candidiasis limited to the bands of onychomadesis exaggerated the appearance of the nail deformity. [source]

A survey of pregnant women's attitude towards breech delivery and external cephalic version

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 3 2000
Tak Yeung Leung
SUMMARY A structured interview survey was carried out in 150 women who came for their first antenatal visit in a university hospital in Hong Kong between June and July 1998. Their opinions and perceptions of fetal and maternal safeties on different modes of delivery for both cephalic and breech presentation, and external cephalic version (ECV) were surveyed. Their decisions on the management of term breech-presenting pregnancy were examined. Most women (92%) preferred vaginal delivery to Caesarean delivery (CS) in case of cephalic presentation, mainly because it was a natural way of parturition. They perceived that vaginal delivery was safer than CS for both mothers and babies, but the reverse was true for breech presentation. About 82% chose ECV as the first choice of managing breech presentation, mainly because a successful version allowed a natural way of delivery. Only 2% of women considered ECV ineffective, and 13.3% and 18.7% considered it not safe for mothers and fetuses respectively. Therefore, ECV should be an available option in all obstetric units. Adequate counselling and explanation would improve the acceptance of ECV. [source]

Cesarean Delivery in Shantou, China: A Retrospective Analysis of 1922 Women

BIRTH, Issue 2 2000
Wang-ling Wu MD
Background:In China the cesarean section rate increased significantly during the past four decades. This study examined the frequency and indications of cesarean birth in Shantou, a southern city in China.Methods:An analysis was conducted of the medical records of 1922 women who had cesarean deliveries at Shantou City 2nd People's Hospital between January 1990 and December 1997. The medical records of 10,490 women who gave birth during this period were examined.Results:The average rate of cesarean delivery during the 8-year period was 19.4 ± 2.3 percent (means ± standard error). From 1990 to 1997 the cesarean delivery rates ranged from 11.05 to 29.9 percent, respectively, although during this period the total annual number of deliveries decreased significantly from 1683 to 951. The rates of the most common indications per 100 women for cesarean delivery were failure to progress (23%), premature rupture of membranes (20%), fetal distress (19.4%), breech presentation (18.1%), uterine scar (14.6%), and prolonged pregnancy (11.3%).Conclusion:The cesarean delivery rate in Shantou, China, has increased steadily and significantly between 1990 and 1997, despite a decrease in the total number of births during the same period. This study showed that on an individual basis vaginal delivery was often possible and reduction of the cesarean delivery rate could be achieved safely by paying greater heed to appropriate indications. [source]

Recurrence of breech presentation in consecutive pregnancies

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 7 2010
JB Ford
Please cite this paper as: Ford J, Roberts C, Nassar N, Giles W, Morris J. Recurrence of breech presentation in consecutive pregnancies. BJOG 2010;117:830,836. Objective, To investigate the recurrence risk of breech presentation at term, and to assess the risk factors that contribute to its recurrence. Design, Cohort study. Setting, New South Wales, Australia. Population, Women with their first two (n = 113 854) and first three (n = 21 690) consecutive singleton term pregnancies, in the period 1994,2002. Methods, Descriptive statistics including rates, relative risks and adjusted relative risks, as determined from logistic regression and Poisson analyses. Main outcome measures, Rates and risks of occurrence and recurrence of breech presentation at birth in each pregnancy, and maternal and infant risk factors associated with breech recurrence. Results, First-time breech presentation at term occurred in 4.2% of first pregnancy deliveries, 2.2% of second pregnancies and 1.9% of third pregnancies. The rate of breech recurrence in a second consecutive pregnancy was 9.9%, and in a third consecutive pregnancy (after two prior breech deliveries) was 27.5%. The relative risk of breech recurrence in a second pregnancy was 3.2 (95% CI 2.8,3.6), and in a third consecutive breech pregnancy was 13.9 (95% CI 8.8,22.1). First pregnancy factors associated with recurrence included placenta praevia [adjusted relative risk (aRR) 2.2; 95% CI 1.3,3.7], maternal diabetes (aRR 1.4; 95% CI 1.0,2.1) and a maternal age of ,35 years (aRR 1.2; 95% CI 0.9,1.6). Second pregnancy factors included birth defects (aRR 2.5; 95% CI 1.4,4.2), placenta praevia (aRR 2.5; 95% CI 1.5,4.1) and a female infant (aRR 1.2; 95% CI 1.0,1.5). Conclusions, The increased recurrence risk of breech presentations suggests that women with a history of breech delivery should be closely monitored in the latter stages of pregnancy. [source]

Oral nifepidine versus subcutaneous terbutaline tocolysis for external cephalic version: a double-blind randomised trial

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 1 2009
R Collaris
Objective, To evaluate oral nifedipine versus subcutaneous terbutaline tocolysis for external cephalic version (ECV). Design, A double-blind randomised trial. Setting, A university hospital in Malaysia. Population, Non-labouring women with a term singleton fetus in breech presentation or transverse lie suitable for elective ECV. Methods, Participants were randomised to either 10 mg oral nifedipine tablet and subcutaneous saline placebo or oral placebo tablet and 250 microgram bolus terbutaline subcutaneously. Participants and providers were blinded. Ultrasound assessment and cardiotocogram were performed prior to ECV. ECV was commenced 20,30 minutes after treatment. A maximum of two ECV attempts were permitted. Elective caesarean delivery or a repeat ECV attempt at a later date was offered to participants following failed ECV. After successful ECV, management was expectant. Main outcome measures, Primary outcomes were successful ECV (cephalic presentation immediately after ECV) and caesarean delivery. Results, Ninety women were randomised: 44 to nifedipine and 46 to terbutaline. Initial ECV success rate was 15/44 (34.1%) versus 24/46 (52.2%) (relative risk [RR] 0.7, 95% CI 0.4,1.1; P= 0.094), and caesarean delivery rate was 34/44 (77.3%) versus 26/46 (56.5%) (RR 1.4, 95% CI 1.01,1.85; numbers needed to treat to benefit 5, 95% CI 2.5,55; P= 0.046) for nifedipine and terbutaline groups, respectively. Neonatal outcome was not different. Conclusions, Bolus subcutaneous terbutaline tocolysis for ECV compared with oral nifedipine resulted in less caesarean deliveries. ECV success rate was not significantly higher. Larger studies are indicated. [source]

Influence of mode of delivery on neonatal mortality in the second twin, at and before term

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 12 2008
A Herbst
Design, To study the association between mode of delivery and neonatal mortality in second twins. To study the association between caesarean delivery and mortality with minimum bias of the indication for the operation, we wanted to compare the outcome of second twins delivered by caesarean due to breech presentation of the sibling with vaginally delivered second twins in uncomplicated pregnancies. Setting, Sweden, 1980,2004 Population, Twins born during 1980,2004 were identified from the Swedish Medical Birth Registry. Twin pairs delivered by caesarean due to breech presentation of the first twin, and vaginally delivered twins with the first twin in cephalic presentation were included. Pregnancies with antepartum complications were excluded. Methods, Odds ratios and 95% CI were calculated using multiple logistic regression analyses, adjusting for year of birth, maternal age, parity and gestational age. Main outcome measures, Neonatal mortality. Results, Compared with second-born twins delivered vaginally, second-born twins delivered by caesarean (for breech presentation of the sibling) had a lower risk of neonatal death (adjusted OR 0.40; 95% CI 0.19,0.83). The decreased risk after caesarean delivery was significant for births before 34 weeks (2.1 versus 9.0%; adjusted OR 0.40; 95% CI 0.17,0.95). After 34 weeks, neonatal mortality was low in both groups (0.1 and 0.2%, respectively), and the difference was not statistically significant (adjusted OR 0.42; 95% CI 0.10,1.79). Conclusions, Neonatal mortality is lower for the second twin after caesarean delivery at birth before 34 weeks. At term, mortality is low irrespective of delivery mode. [source]

Expectation and experiences of childbirth in primiparae with caesarean section

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 3 2008
I Wiklund
Objective, The aim of this study was to examine the expectations and experiences in women undergoing a caesarean section on maternal request and compare these with women undergoing caesarean section with breech presentation as the indication and women who intended to have vaginal delivery acting as a control group. A second aim was to study whether assisted delivery and emergency caesarean section in the control group affected the birth experience. Design, A prospective group-comparison cohort study. Setting, Danderyd Hospital, Stockholm, Sweden. Sample, First-time mothers (n= 496) were recruited to the study in week 37,39 of gestation and follow up was carried out 3 months after delivery. Comparisons were made between ,caesarean section on maternal request', ,caesarean section due to breech presentation' and ,controls planning a vaginal delivery'. Methods, The instrument used was the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ). Main outcome measures, Expectations prior to delivery and experiences at 3 months after birth. Results, Mothers requesting a caesarean section had more negative expectations of a vaginal delivery (P < 0.001) and 43.4% in this group showed a clinically significant fear of delivery. Mothers in the two groups expecting a vaginal delivery, but having an emergency caesarean section or an assisted vaginal delivery had more negative experiences of childbirth (P < 0.001). Conclusions, Women requesting caesarean section did not always suffer from clinically significant fear of childbirth. The finding that women subjected to complicated deliveries had a negative birth experience emphasises the importance of postnatal support. [source]

A randomised controlled trial of moxibustion for breech presentation

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 6 2005
Francesco Cardini
Objectives To evaluate the efficacy of moxibustion for the correction of fetal breech presentation in a non-Chinese population. Design Single-blind randomised controlled trial (RCT). Setting Six obstetric departments in Italy. Sample Healthy non-Chinese nulliparous pregnant women at 32,33 weeks + 3 days of gestational age with the fetus in breech presentation. Methods Random assignment to treatment or observation. Treatment consisted of moxibustion (stimulation with heat from a stick of Artemisia vulgaris) at the BL 67 acupuncture point (Zhiyin) for one or two weeks. Two weeks after recruitment, each participant was subjected to an ultrasonic examination of the fetal presentation. Main outcome measure Number of participants with cephalic presentation in the 35th week. Results The study was interrupted when 123 participants had been recruited (46% of the planned sample). Intermediate data monitoring revealed a high number of treatment interruptions. At this point no difference was found in cephalic presentation in the 35th week (treatment group: 22/65, 34%; control group: 21/58, 36%; RR 0.95; 99% CI 0.59,1.5). Conclusions The results underline the methodological problems evaluating of a traditional treatment transferred from a different cultural context. They do not support either the effectiveness or the ineffectiveness of moxibustion in correcting fetal breech presentation. [source]

Tocolysis for repeat external cephalic version in breech presentation at term: a randomised, double-blinded, placebo-controlled trial

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 5 2005
Lawrence Impey
Background External cephalic version (ECV) reduces the incidence of breech presentation at term and caesarean section for non-cephalic births. Tocolytics may improve success rates, but are time consuming, may cause side effects and have not been proven to alter caesarean section rates. The aim of this trial was to determine whether tocolysis should be used if ECV is being re-attempted after a failed attempt. Objective To determine whether tocolysis should be used if ECV is being re-attempted after a failed attempt. Design Randomised, double-blinded, placebo-controlled trial. Setting UK teaching hospital. Population One hundred and twenty-four women with a breech presentation at term who had undergone an unsuccessful attempt at ECV. Methods Relative risks with 95% confidence intervals for categorical variables and a t test for continuous variables. Analysis was by intention to treat. Main outcome measures Incidence of cephalic presentation at delivery. Secondary outcomes were caesarean section and measures of neonatal and maternal morbidity. Results The use of tocolysis for a repeat attempt at ECV significantly increases the incidence of cephalic presentation at delivery (RR 3.21; 95% CI 1.23,8.39) and reduces the incidence of caesarean section (RR 0.33; 95% CI 0.14,0.80). The effects were most marked in multiparous women (RR for cephalic presentation at delivery 9.38; 95% CI 1.64,53.62). Maternal and neonatal morbidity remain unchanged. Conclusions The use of tocolysis increases the success rate of repeat ECV and reduces the incidence of caesarean section. A policy of only using tocolysis where an initial attempt has failed leads to a relatively high success rate with minimum usage of tocolysis. [source]

Outcome of term breech births: 10-year experience at a district general hospital

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 2 2005
Poonam Pradhan
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 breech infants alive at the onset of labour and born between January 1991 and December 2000. Methods Data abstracted from birth registers, neonatal discharge summaries and the child health database system were used to compare the short and long term outcomes of singleton term breech infants born by two different modes of delivery (prelabour caesarean section and vaginal or caesarean section in labour). Fisher's exact test was used to compare the categorical variables. Main outcome measures Short term outcomes: perinatal mortality, Apgar scores, admission to the neonatal unit, birth trauma and neonatal convulsions. Long term outcomes: deaths during infancy, cerebral palsy, long term morbidity (development of special needs and special educational needs). Results Of 1433 singleton term infants in breech presentation at onset of labour, 881 (61.5%) were delivered vaginally or by caesarean section in labour and 552 (38.5%) were born by prelabour caesarean section. There were three (0.3%) non-malformed perinatal deaths among infants born by vaginal delivery or caesarean section in labour compared with none in the prelabour caesarean section cohort. Compared with infants born by prelabour caesarean section, those delivered vaginally or by caesarean section in labour were significantly more likely to have low 5-minute Apgar scores (0.9%vs 5.9%, P < 0.0001) and require admission to the neonatal unit (1.6%vs 4%, P= 0.0119). However, there was no significant difference in the long term morbidity between the two groups (5.3% in the vaginal/caesarean section in labour group vs 3.8% in the prelabour caesarean group, P= 0.26); no difference in rates of cerebral palsy; and none of the eight infant deaths were related to the mode of delivery. Conclusions Vaginal breech delivery or caesarean section in labour was associated with a small but unequivocal increase in the short term mortality and morbidity. However, the long term outcome was not influenced by the mode of delivery. [source]