Trial of Vaginal Breech Delivery: Current Role

Term breech presentation vaginal births in Tibet: A retrospective analysis of 451 cases

Background

In high altitude areas, like Tibet, most fetuses in breech presentation at term are delivered vaginally owing to a variety of reasons, but this has not been published.

Objective

This study aimed to provide references and evidence for the delivery of breach presentation term fetuses in high altitude areas, through comparing and analyzing the data of full-term singleton fetuses with breech or cephalic presentation in Naqu People's Hospital, Tibet.

Study design

We retrospectively analyzed the clinical data of 451 breech presentation fetuses mentioned above over a period of 5  years (2016-2020). A total of 526 cephalic presentation fetuses' data within 3  months (1 June to 1 September 2020) of the same period were collected too. Statistics were compared and assembled on fetal mortality, Apgar scores, and severe neonatal complications for both planned cesarean section (CS) and vaginal delivery. In addition, we also analyzed the types of breech presentation, the second stage of labor, and damage to the maternal perineum during vaginal delivery.

Results

Among the 451 cases of breech presentation fetuses, 22 cases (4.9%) elected for CS and 429 cases (95.1%) elected for vaginal delivery. Of the women who chose vaginal trial labor, 17 cases underwent emergency CSs. The perinatal and neonatal mortality rate was 4.2% in the planned vaginal delivery group and the incidence of severe neonatal complications was 11.7% in the transvaginal group, no deaths were detected in the CS group. Among the 526 cephalic control groups with planned vaginal delivery, the perinatal and neonatal mortality was 1.5% (p = 0.012), and the incidence of severe neonatal complications was 1.9%. Among vaginal breech deliveries, most of them were complete breech presentation (61.17%). Among the 364 cases, the proportion of intact perinea was 45.1%, and first degree lacerations accounted for 40.7%.

Conclusion

In the Tibetan Plateau region, vaginal delivery was less safe than cephalic presentation fetuses for full-term breech presentation fetuses delivered in the lithotomy position. However, if dystocia or fetal distress can be identified in time and then encouraged to convert to cesarean, its safety will be greatly improved.

Comparison of outcomes between induction of labor and spontaneous labor for term breech - A systemic review and meta analysis

OBJECTIVES

Few studies have assessed the impact of induction of labor on breech presentation. This study aims to summarize the effect of induction of labor of breech presentation on perinatal morbidity.

METHODS

Literature review was done in Medline, Embase, Web of science and Cochrane Library up to 20 October 2017. Randomized control studies, cohort studies, and case control publishing studies comparing induction of labor versus spontaneous labor of singleton live breech birth were included. Perinatal morbidity was calculated by RevMan 5 and presented by pooled odds ratio with 95% confidence intervals.

RESULTS

Cesarean section rate and neonatal intensive care unit admission were increased in induction of breech labor as compared with spontaneous breech labor. No significant difference in umbilical cord blood base excess ≤ -12 mmol/L, Apgar 5 min < 7, Apgar 5 min < 4, umbilical cord blood PH < 7, neonatology unit admission, maternal fever, and intrapartum stillbirth between the two groups was found.

CONCLUSIONS

Induction of breech labor has higher cesarean section rate and NICU perinatal morbidity compared to spontaneous breech labor. The neonatal outcomes were otherwise similar across both groups. Eligibility for induction of breech labor needs to be assessed carefully according to individual situation.

Vaginal delivery or cesarean section at term breech delivery--chance or risk?

AIM

The aim of the study was to examine maternal age, parity, and estimated neonatal birth weight (BW) depending on the mode of a full-term breech presentation (BP) birth delivery and neonatal outcomes.

MATERIAL AND METHODS

One hundred and forty-six singleton term breech presentation pregnancies were included in a retrospective study conducted at the Department of Gynecology/Obstetrics, Clinical Center of Serbia in Belgrade in 2013. Statistical analysis: Student's-t test, χ(2) likelihood ratio, and the Fisher's exact test. The level of statistical significance was set at p <0.05.

RESULTS

An ECS was the most common mode of delivery in (81.2%) nulliparous older than 35 years and most of the neonates (66.67%) with an estimated birth weight (BW) above 3500 grams were delivered by elective cesarean section (ECS). Perinatal asphyxia remained increased in the successful vaginal delivery (SVD) group (23.8%) compared with the urgent CS (UCS) group (13.3%) (p = 0.035). Birth asphyxia was the most common in neonates were delivered by SVD (23.8%). There were no cases of perinatal deaths.

CONCLUSION

ECS remained the recommended mode of breech term delivery in nulliparous women older than 35 years, as well as in neonates with an estimated BW above 3500 grams.

Incidence of perinatal complications in children with premature craniosynostosis

AIMS

To study the incidence of perinatal complications in children diagnosed with premature craniosynostosis and their mothers.

METHODS

Questionnaires were sent to all women (n=220) who delivered a child diagnosed either pre- or postnatally with craniosynostosis and treated at the University Hospital of Innsbruck, Austria between January 1, 1990 and October 10, 2007. The incidence of various complications in the group of children with craniosynostosis was compared with data from the Birth Registry of Tyrol, which served as a comparison population in this study (n=57,317).

RESULTS

A total of 46.4% of the questionnaires were returned (n=102). Children diagnosed with craniosynostosis showed a significantly higher rate of fetal malpresentations at birth [P<0.001; OR 2.38 (CI 1.53-3.70)] compared to the general population. In particular, the rate of abnormal cephalic [P<0.001; OR 3.42 (CI 2.03-5.76)] and breech presentations [P=0.01; OR 2.39 (CI 1.27-4.49)] was significantly increased. In 10% of all neonates the Apgar score (P=0.001) as well as the pH-value (P<0.001) was found to be at least one category lower than in the comparison population.

CONCLUSIONS

Children diagnosed with craniosynostosis have a significantly higher rate of numerous birth complications compared to the overall births documented at the Birth Registry of Tyrol.

Is there a place for selective vaginal breech delivery in Malaysian hospitals: experiences from the Ipoh Hospital

BACKGROUND

The 'Term Breech Trial' (TBT) results of 2001 have impacted on the mode of delivery of breech with a low threshold for caesarean delivery (CD) worldwide.

AIMS

The trends in mode of delivery in developing countries have also changed. The aims of this retrospective analysis of all breech presentation was to see if similar trends are seen in Ipoh Hospital in Malaysia and if perinatal outcome is affected by mode of delivery.

METHODS

All breech pregnancies presenting in the labour at the Ipoh Hospital, Malaysia, irrespective of gestation or booking status were analysed with respect to mode of delivery, fetal outcome and maternal mortality.

RESULTS

Out of 4886 breech presentation between 1992 and 2004, 3725 cases were evaluable. The prevalence of breech at birth was 3%. Vaginal breech deliveries decreased from 70.4% in 1994 to 13.1% in 2004. Consequently, CDs rose to 86.9% in CDs. There were 107 perinatal deaths (1994-2004) in the series and the crude perinatal mortality rate (PNMR) was four times higher than the hospital PNMR (11.4/1000 in 2004).

CONCLUSION

Although the CD rates rose exponentially with the release of the 'TBT', the mode of delivery did not impact on better PNMR in breech cases in this hospital. The need for selective vaginal births for breech, increased use of external cephalic version and the long implications of a uterine scar in future pregnancies in the 'shared antenatal care in the local context in a developing country is discussed.

Neonate - newborn condition and prematurity with breech delivery

Introduction. Before birth, most of foetuses located in mother's uterus have head presentation down towards the breech exit. Preterm delivery presents the delivery before the end of the 37th gestational week. Etiology of preterm breech deliveries is the same as of the ones at term, such as uterine malformations and myomas, polyhydramnion, foetal abnormalities, high parity, short umbical cord, placenta previa. The complications include passing of the body through insufficiently dilated cervical channel and 'capturing' of the head, umbilical cord prolapse, intrapartal hipoxy, discoordinated delivery, aspiration pneumonia, traumatic injuries. The basic aim of the research was to determine prematurity, mortality, colority of the amniotic fluid, and newborn condition with breech deliveries comparing to the head presentation deliveries. Material and methods. The study group consisted of 282 newborns that came from breech deliveries and the same number of the controls born with head presentation. In cases of breech deliveries there was greatly higher quantity of green and meconium amniotic fluid, significantly higher prematurity, significantly lower average Apgar score as well as seven times higher mortality of newborns comparing with the values in head presentation deliveries. Discussion. Meconium amniotic fluid can result in greater risk than aspiration pneumonia which is the characteristics of breech deliveries. There are more causes endangering fetal vitality after breech delivery and those are along with prematurity, gretaer number of congenital malformations, often traumas which depend on delivery course as well as hipoxy caused during delivery. Prematurity of fetus is one of risk factors resulting in breech delivery but it is also its main characteristics. Conclusion. Breech delivery brings greater risk measured by Apgar score values, appearance of meconium amniotic fluid, prematurity with its consequences and perinatal mortality.

Long-term neurologic outcome of infants born by cesarean section

Prevention of neurologic injury to the fetus through skilled and attentive care during the peripartum period is designed to identify signs of fetal distress so that appropriate obstetric interventions can occur. The impact of mode of delivery on neurologic outcome varies depending on the clinical indication for cesarean delivery and the associated maternal and fetal conditions. This review summarizes current knowledge of the impact of mode of delivery on long-term neurologic outcome.