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Breech vaginal delivery at or near term
Modupe O Tunde-Byass1, Mary E Hannah
1Department of Obstetrics and Gynaecology, Sunnybrook and Women's College Health Sciences Centre, Maternal Infant and Reproductive Health Research Unit at the Centre for Research in Women's Health, University of Toronto, Toronto, Ontario, Canada.
Seminars in Perinatology
|March 19, 2003
Summary
Planned cesarean delivery is safer for term breech babies. This review identifies risk factors for adverse outcomes during vaginal breech birth, aiding informed decisions for women who cannot or prefer not to have a cesarean.
Area of Science:
- Obstetrics and Gynecology
- Perinatal Medicine
- Fetal Surgery
Background:
- Approximately 3-4% of term fetuses present in breech position.
- Planned cesarean delivery is proven safer for term breech fetuses than planned vaginal birth.
- Some women may prefer or require vaginal breech delivery.
Purpose of the Study:
- To identify risk factors for adverse fetal/neonatal outcomes in term vaginal breech deliveries.
- To inform clinical practice and patient counseling regarding vaginal breech birth risks.
Main Methods:
- Systematic review of MEDLINE (1966-2002) and reference lists.
- Inclusion of articles on vaginal breech delivery and breech presentation.
- Analysis of factors associated with fetal/neonatal outcomes.
Main Results:
- Higher risk factors include advanced maternal age, footling presentation, hyperextended fetal head, estimated fetal weight <2500g or >4000g.
- Prolonged labor and lack of experienced clinician increase adverse outcome risk.
- Planned cesarean delivery reduces adverse fetal/neonatal outcomes.
Conclusions:
- Women with term breech presentation should be offered planned cesarean delivery due to reduced risks.
- Clinicians must maintain skills for vaginal breech delivery for women unable or unwilling to undergo cesarean section.