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How perinatologists manage the problem of the presenting breech
E Amon1, B M Sibai, G D Anderson
1Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri 63110.
American Journal of Perinatology
|July 1, 1988
Summary
Maternal-fetal medicine specialists report legal concerns influence breech presentation management. Despite limited evidence, cesarean delivery is common for preterm breech, highlighting the need for further research on optimal delivery modes.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Perinatal Care
Background:
- Management of the breech presentation remains a controversial topic in obstetrics.
- Clinical practice patterns may be influenced by factors beyond current evidence, such as legal concerns.
Purpose of the Study:
- To survey maternal-fetal medicine subspecialists regarding their views and practices in managing breech presentations.
- To identify areas of consensus and controversy in breech delivery management, particularly concerning preterm and term presentations.
Main Methods:
- A questionnaire was distributed to 405 maternal-fetal medicine subspecialists.
- The survey addressed clinical management, perceived safety and efficacy of interventions, and opinions on evidence adequacy for different breech presentations.
Main Results:
- Legal concerns significantly impacted clinical decisions for 63% of respondents.
- External cephalic version was widely considered safe (90%) and effective (83%).
- Despite limited agreement on evidence favoring cesarean section for preterm breech (28-31 and 32-34 weeks), cesarean delivery was performed in 94% and 83% of these cases, respectively.
- A strong consensus (over 75%) exists for the need for prospective studies on preterm breech delivery, with 92% indicating such data would influence their practice.
Conclusions:
- Clinical management of breech presentation is influenced by legal considerations.
- There is a significant gap between the perceived evidence base and actual clinical practice for preterm breech deliveries.
- Further high-quality research, particularly prospective studies, is crucial to guide optimal management strategies for preterm breech presentations.