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Malpresentation And Malposition
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Alexis C. Gimovsky, Andrea Dall’Asta, Giovanni Morganelli, Tullio Ghi
Fetal breech presentation is further classified as follows:Complete: Flexion of the fetal hips and kneesIncomplete: Extension of one or both hips (includes footling)Frank: Flexion at the hips and extension at the knees
Breech presentation
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Randall C. Floyd, Martin L. Gimovsky
Breech presentation is a significant obstetric event associated with dramatic increases in perinatal morbidity and mortality (1,2). The three areas of greatest risk for these infants are the often overlapping problems of preterm delivery, congenital anomalies, and birth trauma. More than one quarter of breech-presenting fetuses are premature. Concomitantly, severe or lethal anomalies further complicate up to 20% of such preterm deliveries and fully 6% to 7% of term breech deliveries (a relative risk of three- to fivefold), depending on gestational age. The outcome of vaginal breech delivery has always been noted to be associated with a higher risk of neonatal injury with both short-term and long-term morbidity as well as an increased risk of neonatal death. These risks have led to numerous attempts to evaluate the risk of vaginal breech delivery versus that of elective cesarean delivery for the persistent breech at term. The results of studies published prior to the Term Breech Trial (TBT) (3) in 2000 were inconclusive with some showing no increased risk of vaginal breech delivery and some showing an increased risk of fetal injury and death in those infants delivered vaginally. These studies were, for the most part, small and retrospective, which left room for error in their conclusions. In 2000 the publication of the TBT, a randomized, multinational multi-center trial that incorporated all levels of care in both advanced and developing countries, demonstrated a clear benefit to the delivery of the term fetus in a breech presentation by elective cesarean.
DRCPG MCQs for Circuit A Answers
Published in Una F. Coales, DRCOG: Practice MCQs and OSCEs: How to Pass First Time three Complete MCQ Practice Exams (180 MCQs) Three Complete OSCE Practice Papers (60 Questions) Detailed Answers and Tips, 2020
A breech presentation is associated with bony pelvic abnormalities, uterine anomalies, multiparity, prematurity, multiple pregnancy, placenta praevia and hydramnios. An abnormal lie is a contraindication for forceps delivery. A footling or flexed breech presentation should be delivered by Caesarean section. A trial of vaginal delivery using Pinard's and Lovset's manoeuvre may be attempted for breech babies or the external cephalic version after 33 weeks.
Analysing the likelihood of caesarean birth after implementation of the two-childbirth policy in China, using the Ten Group Classification System
Published in Journal of Obstetrics and Gynaecology, 2020
Jie Wen, QinQing Chen, Qiong Luo
As a result of the two-childbirth policy, the number of women in Group 7 (multiparous women with a single breech pregnancy) has grown rapidly and has included a large proportion of multiparous women with previous vaginal births. Those women typically do not prefer having a planned Caesarean section delivery because of the increasing risks the mothers face, in comparison to a vaginal delivery. However, many hospitals and obstetricians have been reluctant to offer assisted breech delivery and breech extraction. In view of this, it is a viable option to convert breech presentation into cephalic presentation by carrying out an ECV. Increasing studies have shown that ECV attempt at term is not associated with increased prenatal morbidity or mortality (Son et al. 2018). Additionally, ECV is accepted and widely attempted in many countries (Mowat and Gardener 2014; Ebner et al. 2016). About 100 women have received an ECV attempt in our hospital since 2018. The success rate of ECV is 51.6% (49 in 95), and even higher in Group 7 (65.8%, 25 in 38) (data not shown in the present study). Despite the fact that this group is relatively small, ECV is an important intervention that may help reduce Caesarean birth rates.
Vaginal birth in breech presentation in morbidly obese woman
Published in Journal of Obstetrics and Gynaecology, 2018
Milan Stefanović, Bojan Lukic, Ranko Kutlešić, Predrag Vukomanović
Breech presentation at term occurs in about 3–4% of pregnant women (Walker 2013). From the literature to-date, we could only identify one case‐control study of the effectiveness of the all‐fours position for vaginal breech birth (Bogner et al. 2015). This study showed that vaginal breech birth in the all‐fours position was accomplished spontaneously in 70.7%. In 19.5% assisting manoeuvres were deemed necessary. Severe perineal injury was reported less often in women who gave birth on all-fours (14.6%) when compared to the matched control group of women who gave birth in lithotomy position (58.5%). However, this study does not refer to morbidly obese women. Keeping in mind the risks, being aware of the safety of both the woman and the infant and having the woman’s consent, we judged to the best of our professional ability that the all-fours position would be the safest way of delivery, although the continuous CTG monitoring could not be done and vaginal examination was unusual due to obesity. Our decision is consistent with the latest RCOG guidelines (Impey et al. 2017).
Maternal and neonatal outcomes in the following delivery after previous preterm caesarean breech birth: a national cohort study
Published in Journal of Obstetrics and Gynaecology, 2022
Anna Toijonen, Pia Hinnenberg, Mika Gissler, Seppo Heinonen, Georg Macharey
Caesarean section rates are increasing worldwide (Hehir et al. 2018), also in preterm pregnancies. Many studies have been carried out to access if a caesarean section has a benefit for neonates born preterm (Muhuri et al. 2006; Herbst and Kallen 2007; Robilio et al. 2007; Haque et al. 2008; Deutsch et al. 2011; Demirci et al. 2012; Alfirevic et al. 2013; Bergenhenegouwen et al. 2014; Azria et al. 2016). Nevertheless, the results of these studies remain controversial. The National Institute of Health and Care Excellence guideline recommends consideration of caesarean section for all women in preterm labour with a singleton breech foetus (National Collaborating Centre for Women's and Children's Health (UK) 2015). The reason for this is perhaps that several studies have suggested that preterm foetuses in breech presentation delivered by a primary caesarean section have a significantly lower risk of neonatal mortality compared with those delivered vaginally (Muhuri et al. 2006; Herbst and Kallen 2007; Robilio et al. 2007; Deutsch et al. 2011; Demirci et al. 2012; Bergenhenegouwen et al. 2014; Azria et al. 2016). Breech presentation is also in preterm pregnancies associated with obstetric risk factors, which are often an indication for a planned caesarean section (Toijonen et al. 2020). The Royal College of Obstetricians and Gynaecologists Breech Delivery Guideline from 2017 stated that the mode of birth in spontaneous singleton preterm breech deliveries should be decided individually based on the maternal and foetal factors (Impey et al. 2017). Also, the Cochrane review from 2013 did not recommend the mode of birth in preterm breech deliveries (Alfirevic et al. 2013).