Outcome of 1040 consecutive breech deliveries: clinical experience of a maternity hospital in Turkey

Genital injuries in neonates following breech presentation

Breech presentation is seen in 3-4% of babies born. Delivering a breech baby through vaginal route is difficult and carries a much higher complication rate than cesarean sections. Breech born babies carry an overall increased risk of maternal morbidity, neonatal mortality, birth asphyxia and birth injuries. Various types of birth injuries to the babies have been reported following breech delivery, but genital injuries are less commonly reported and thus, less anticipated. We report series of five babies with spectrum of genital injuries following breech delivery. These injuries led to significant short and long term morbidity in these babies. Keeping high index of suspicion, an early cesarean section can be an aide in preventing these complications. Once the baby is born, careful examination and early intervention should be done to prevent long term complications.

Trial of labor and vaginal birth after cesarean section in patients with uterine Müllerian anomalies: a population-based study

OBJECTIVE

The aim of our study was to determine the success rate of vaginal birth after cesarean section among patients with Müllerian anomalies in comparison to the success rate of vaginal birth after cesarean section in patients with normal uterus with emphasis on the rate of uterine rupture.

STUDY DESIGN

A retrospective population-based study was designed, including all patients with a previous cesarean section that attempted vaginal birth after cesarean section during the study period. Women with known Müllerian anomalies were included in the study group. The control group consisted of women with normal uterus. The rates of vaginal birth after cesarean section, uterine rupture, maternal morbidity, and perinatal outcome were compared between the groups.

RESULTS

Of 5571 eligible patients, 165 (2.96%) had Müllerian anomalies. The rate of vaginal birth after cesarean section was significantly lower among patients with Müllerian anomalies than in patients with normal uterus, 37.6% (62/165) vs 50.7% (2740/5406), respectively (P = .0009). During the study period, there were 10 cases of uterine rupture, all in patients with normal uterus. The major indication for repeated cesarean delivery among Müllerian anomalies patients was malpresentation, 58.3% (60/103) vs 14.4% (385/2666) in patients with normal uterus (P < .001).

CONCLUSION

A trial of vaginal birth after cesarean section in patients with uterine Müllerian malformations and cephalic presentation is not associated with a higher rate of maternal morbidity and uterine rupture.

Management of birth injuries

Birth injuries are a significant cause of neonatal morbidity and mortality. Although often associated with traumatic delivery, birth injuries often occur in normal spontaneous deliveries in the absence of any risk factors. This article discusses the diagnosis and management of the most common birth injuries that are encountered by health care providers who care for newborns.

Management of birth injuries

Birth injuries are a significant cause of neonatal morbidity and mortality. Although they are frequently associated with traumatic delivery, birth injuries often occur in normal spontaneous deliveries in the absence of any risk factors. This article discusses the diagnosis and management of the most common birth injuries encountered by health care providers caring for newborns.

Obstetric brachial plexus palsy associated with breech delivery

A review of the English literature revealed that only two birth palsy centers have specifically reviewed their experience with obstetrical palsy associated with breech delivery. The aim of this paper is to review the author's center's experience with birth palsy associated with breech delivery, compare their epidemiological and surgical findings with previous studies, and describe their management approach to this unique injury. A total of 34 limbs were studied. Erb's palsy was seen in 32 limbs and total palsy was seen in the remaining 2 limbs. The mean birth weight was low (2.3 kg). Six patients had bilateral lesions and 3 patients had phrenic nerve palsy. In their center, the indication for primary brachial plexus exploration is the lack of active elbow flexion against gravity at 4 months of age. A study of the natural history showed that 58% of limbs had full spontaneous recovery, 21% had good but partial recovery, and the prognosis was considered to be poor in the remaining 21% of limbs because active elbow flexion was not evident by 4 months of age. Intraoperatively, the usual lesion was C5/C6 avulsion or avulsion in situ, which seemed to be specific for breech deliveries. Their approach for management is described, including the role of Oberlin's ulnar nerve to biceps nerve transfer in these cases. Finally, the lack of contractures at the shoulder and elbow in these patients are explained.

Route of breech delivery and maternal and neonatal outcomes

OBJECTIVE

To compare maternal and neonatal outcomes in elective cesarean vs. attempted vaginal delivery for breech presentation at or near term.

METHODS

We reviewed the maternal and neonatal charts of all singleton breech deliveries of at least 35 weeks' gestation or 2000 g delivered between 1986 and 1997 at our institution. Patients delivered by elective cesarean were compared to those attempting a vaginal delivery. The neonatal outcomes analyzed were: corrected mortality; Apgar scores less than 7 at 5 min; abnormal umbilical cord blood gases; birth trauma; and admissions to the intensive care nursery. Maternal morbidity was also assessed and compared.

RESULTS

Of 848 women meeting criteria for evaluation, 576 were delivered by elective cesarean while 272 attempted a vaginal delivery. Of 272 women undergoing a trial of labor, 203 (74.6%) were delivered vaginally, while 69 (25.4%) failed an attempt at vaginal delivery and underwent a cesarean. When comparing patients delivered by elective cesarean with those attempting a vaginal delivery, no significant differences were noted in neonatal outcomes. However, maternal morbidity was higher among women delivered by cesarean, regardless of the indications for the procedure. Similar neonatal and maternal results were noted when nulliparous patients were analyzed separately.

CONCLUSIONS

Cesarean delivery of selected near-term infants presenting as breech is associated with increased maternal morbidity without corresponding improvement in neonatal outcomes.