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The management of breech presentation at term
1Academic Department of Obstetrics & Gynaecology, North Staffordshire Maternity Hospital, Newecastle Road, Stoke on Trent, Staffs ST4 6OG, UK. peter.young@nstaffsh.wmids.nhs.uk
Current Opinion in Obstetrics & Gynecology
|November 15, 2001
Summary
Breech presentation complicates 3-4% of term pregnancies. Management focuses on external cephalic version (ECV) and caesarean sections, with a declining acceptance of vaginal breech birth.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
Background:
- Breech presentation occurs in 3-4% of term singleton pregnancies.
- Management options include external cephalic version (ECV), planned cesarean, or attempted vaginal birth.
- There is a growing trend to avoid vaginal breech delivery, accelerated by the Term Breech Trial.
Purpose of the Study:
- To evaluate the current management strategies for term breech presentation.
- To discuss the implications of the Term Breech Trial on clinical practice.
- To advocate for increased focus on ECV as a primary management option.
Main Methods:
- Review of current obstetric management guidelines and clinical trends.
- Discussion of the impact of key research, such as the Term Breech Trial.
- Analysis of the balance between ECV, cesarean section, and vaginal birth for breech presentation.
Main Results:
- The choice for breech presentation management is increasingly limited to ECV or elective cesarean.
- Vaginal breech birth is becoming less accepted in many centers.
- The Term Breech Trial is likely to further reduce the rates of planned vaginal breech birth.
Conclusions:
- The focus should shift towards optimizing ECV rates, uptake, and success.
- Improving ECV success can offer an alternative to cesarean delivery for breech presentation.
- Enhanced strategies for ECV may improve outcomes for breech pregnancies.