Related Experiment Videos
Singleton vaginal breech delivery at term: still a safe option.
May Alarab1, Carmen Regan, Michael P O'Connell
1Departments of Obstetrics and Gynaecology, University College Dublin, National Maternity Hospital, Holles Street, Dublin 2, Ireland.
Obstetrics and Gynecology
|March 3, 2004
Summary
Safe vaginal breech delivery at term is achievable with strict patient selection and adherence to a careful intrapartum protocol. This approach effectively identifies larger infants for cesarean delivery, ensuring positive obstetric and perinatal outcomes.
Area of Science:
- Obstetrics and Gynecology
- Perinatal Medicine
- Maternal-Fetal Medicine
Background:
- Breech presentation at term complicates delivery planning.
- Vaginal breech delivery outcomes are influenced by selection criteria and intrapartum management.
- Previous studies have shown varied results regarding the safety of planned vaginal breech delivery.
Purpose of the Study:
- To evaluate the obstetric and perinatal outcomes of term singleton breech presentations managed with specific prelabor and intrapartum selection criteria for vaginal delivery.
- To assess the effectiveness of a protocol designed to identify suitable candidates for vaginal breech birth.
- To determine if strict criteria can ensure safe outcomes for both mother and infant.
Main Methods:
- Retrospective review of pregnancies with singleton breech presentation after 37 weeks gestation (January 1997-June 2000).
- Criteria for prelabor cesarean or trial of vaginal delivery included breech type, estimated fetal weight (>3,800g), maternal preference, and gestational age (>41 weeks).
- Intrapartum protocol excluded labor induction/augmentation, utilized a low threshold for cesarean for dystocic labor, and required an experienced obstetrician's attendance.
Main Results:
- Of 641 women, 343 (54%) had prelabor cesarean, and 298 (46%) attempted vaginal delivery, with 146 (49%) succeeding.
- Nulliparas had lower vaginal delivery success rates (37%) compared to multiparas (63%).
- Infants >3,800g were more frequently selected for cesarean delivery (20-25%) than delivered vaginally (10%). Neonatal outcomes were excellent, with only two infants (0.7%) having Apgar scores <7, both neurologically normal at 6 weeks. No nonanomalous perinatal deaths occurred.
Conclusions:
- Strict selection criteria, a defined intrapartum protocol, and experienced obstetrician attendance are crucial for safe vaginal breech delivery at term.
- The established protocol effectively identifies larger infants, directing them towards cesarean delivery and optimizing safety.
- This approach supports the feasibility of vaginal breech birth in carefully selected cases, minimizing adverse perinatal events.