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Intrapartum management of breech presentation
1Division of Maternal-Fetal Medicine, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School/St. Peter's Medical Center, New Brunswick, USA.
Clinics in Perinatology
|March 1, 1996
Summary
Breech presentation increases risks for newborns. Careful selection of term frank breeches for vaginal delivery or cesarean delivery for others can improve outcomes, with specific techniques for low-birth-weight infants.
Area of Science:
- Obstetrics and Gynecology
- Perinatal Medicine
- Neonatal Outcomes
Background:
- Breech presentation is linked to higher rates of perinatal morbidity and mortality.
- Complications include cord compression, nuchal arm, and difficult delivery of the aftercoming head.
Purpose of the Study:
- To evaluate optimal delivery strategies for term breech presentation.
- To identify criteria for successful vaginal breech delivery versus cesarean delivery.
- To assess the impact of external cephalic version (ECV) on cesarean rates.
Main Methods:
- Review of clinical protocols for vaginal breech delivery.
- Analysis of outcomes based on fetal presentation, size, and pelvic dimensions.
- Consideration of cesarean delivery techniques for specific infant populations.
Main Results:
- Strict protocols for selecting term, normal-sized frank breeches with adequate pelvic dimensions can yield good vaginal delivery outcomes.
- Cesarean delivery is recommended for breech presentations not meeting strict selection criteria.
- External cephalic version (ECV) effectively reduces breech presentation incidence but has minimal impact on overall cesarean delivery rates.
Conclusions:
- Careful patient selection is crucial for successful vaginal breech delivery.
- Cesarean delivery should be strongly considered for high-risk breech presentations.
- Specific surgical and anesthetic techniques are vital for cesarean deliveries of very low-birth-weight breech infants.