External cephalic version - the bad, the good and the what now?

Abstract

Breech presentation occurs in 3–4% of pregnancies and is associated with advanced maternal age, nulliparity, uterine abnormality, multiple pregnancy, prematurity and low birth weight. Protective factors include multiparity and Sub-Saharan ethnicity. Vaginal breech delivery is not without complications with the fetus at risk of hypoxia due to umbilical cord compression or entrapment of the after-coming head. Delivery of the head is made more difficult and prolonged in the presence of a nuchal arm, further increasing the risk of hypoxia and birth trauma. The Term Breech Trial in 2000 found that planned caesarean delivery was associated with a lower risk of perinatal/neonatal mortality or serious neonatal morbidity (1.6%) than vaginal delivery (5.0%). Neurodevelopment of children at two years of age was, however, the same irrespective of the mode of delivery. Despite this information, and criticisms of the Term Breech Trial methodology, there has been a clear change in practice with a reduction in the vaginal breech delivery rate at term and a subsequent widespread increase in the caesarean section rate, although without a reduction in long-term perinatal morbidity and mortality. This change in clinical practice has inevitably contributed to a reduction in the number of clinicians with the skill to conduct a vaginal breech delivery safely. Whilst an elective caesarean section may reduce mortality and serious morbidity, it does not address the problem of women who present with a breech baby in active labour. Even if these women are delivered by emergency caesarean section, there is an increased risk of maternal morbidity associated with difficult surgery and the baby can still suffer traumatic delivery if the presenting part is very low in the maternal pelvis.

DOI: 10.1016/j.ijoa.2013.10.001

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@article{George2014ExternalCV, title={External cephalic version - the bad, the good and the what now?}, author={Rhett George and Navnita Singh and Steve M Yentis}, journal={International journal of obstetric anesthesia}, year={2014}, volume={23 1}, pages={4-7} }