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Breech presentation and delivery
1Division of Obstetrics and Gynaecology, Medical Faculty, University of Papua New Guinea.
What constitutes proper management for the singleton baby who presents by the breech at term has remained one of the most contentious subjects in obstetric practice. Perinatal morbidity and mortality are much higher in breech than in cephalic presentation. Elective caesarean section has been increasingly used in an attempt to improve the perinatal outcome. But caesarean section has immediate and late maternal complications. Some of these complications can be catastrophic. External cephalic version (ECV) at term, under tocolysis if necessary, will reduce the incidence of vaginal breech delivery and the incidence of caesarean section. Where ECV fails, the use of a selective management protocol will allow trial of breech labour in suitable cases, thus further reducing the incidence of elective section. Symphysiotomy may save the life of the baby whose head is trapped by disproportion.
What constitutes proper management for the singleton baby who presents by the breech at term has remained one of the most contentious subjects in obstetric practice. Perinatal morbidity and mortality are much higher in breech than in cephalic presentation. Elective caesarean section has been increasingly used in an attempt to improve the perinatal outcome. But caesarean section has immediate and late maternal complications. Some of these complications can be catastrophic. External cephalic version (ECV) at term, under tocolysis if necessary, will reduce the incidence of vaginal breech delivery and the incidence of caesarean section. Where ECV fails, the use of a selective management protocol will allow trial of breech labour in suitable cases, thus further reducing the incidence of elective section. Symphysiotomy may save the life of the baby whose head is trapped by disproportion.