An alternative approach to assisted vaginal breech delivery

The immediate neonatal outcome by 2 different methods of assisted vaginal breech delivery was studied. In group A, spontaneous expulsion only up to the hip was allowed with one contraction and bearing down efforts; the rest of the baby was delivered with assistance with the next contraction and bearing down efforts. In group B the mother was allowed to expel the fetus up to the shoulders (with assistance) during one contraction and bearing down efforts, followed by assisted delivery of the head with the next uterine contraction and bearing down efforts. A decline in fetal blood pH (greater than 0.10) from the onset of delivery to cord arterial blood pH was more common in group B compared to group A; the difference being almost statistically significant (p = 0.54). Newborns with 1 min Apgar score less than 4 and with a need for assisted ventilation were significantly more common in group B (p less than 0.05). Exposure, stretching and compression of the umbilical cord for a longer time and possible separation of the placenta in group B may be the reason for such an outcome. Further studies are needed to establish the possible advantage of the method of delivery adapted in group A.