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Breech presentation and cesarean section in term nulliparous women
J R Leiberman1, D Fraser, M Mazor
1Department of Obstetrics and Gynecology, Soroka Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
Summary
Cesarean section is recommended for nulliparous women with a term singleton breech presentation. Vaginal delivery in this group was associated with worse Apgar scores and higher neonatal morbidity, while cesarean sections increased maternal morbidity.
Area of Science:
- Obstetrics and Gynecology
- Perinatology
- Maternal-Fetal Medicine
Background:
- Singleton breech presentation at term in nulliparous women presents delivery challenges.
- Management strategies for term singleton breech presentation have varied, impacting outcomes.
Purpose of the Study:
- To compare pregnancy outcomes in nulliparous women with term singleton breech presentation.
- To evaluate the safety and efficacy of trial of labor versus elective cesarean section for this obstetric condition.
Main Methods:
- A prospective, blinded study comparing two delivery approaches in nulliparous women with term singleton breech presentation.
- Systematic alternate assignment to either a trial of labor (Department A) or elective cesarean section (Department B) over 8 years.
- Outcomes assessed included Apgar scores, mortality, and maternal/neonatal morbidity (trauma, neurological signs, respiratory issues).
Main Results:
- Vaginal delivery in the trial of labor group was associated with significantly worse Apgar scores and higher neonatal morbidity, including non-neurological trauma and neurological signs.
- Cesarean sections, while increasing maternal morbidity, resulted in better neonatal outcomes compared to vaginal breech births.
- No intrapartum deaths occurred; one postpartum death was linked to vaginal delivery.
Conclusions:
- Cesarean section is suggested as the preferred delivery route for nulliparous women with term singleton breech presentation due to associated risks.
- The findings indicate a need for careful consideration of delivery method to optimize maternal and neonatal outcomes in this specific obstetric scenario.