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Schauer M, Latartara E, Alonso-Espias M, Rossetti E, Gebert P, Henrich W, Hinkson L. Depression, anxiety and stress in women with breech pregnancy compared to women with cephalic presentation-a cross-sectional study. Arch Gynecol Obstet 2023; 307:409-419. [PMID: 35344082 PMCID: PMC9918572 DOI: 10.1007/s00404-022-06509-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/04/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE This study aims to evaluate the level of psychological distress for women with breech compared to cephalic presentation. We hypothesized, that women with breech presentation have higher levels of depression, stress and anxiety. Secondary objectives were to analyze potential demographic risk factors and comorbidity of psychological distress in breech pregnancy. METHODS The breech study group was formed by 379 women with breech presentation. A sample of 128 women with cephalic presentation was recruited during routine clinical care. Depression, anxiety and stress symptoms were ascertained by means of the Depression-Anxiety-Stress-Score (DASS)-21 questionnaire. Categorial data was analyzed with Chi-square or exact test, continuous data with unpaired t test or Mann-Whitney U test. Demographic risk factors were identified using a binary logistic regression model. RESULTS Prevalence of psychological distress among women with breech was not higher compared to those of other pregnant women. Symptomatic depression, anxiety and stress affected 5.8%, 14.5% and 11.9% of women with breech, respectively. Decreasing age was identified as a risk factor for anxiety (p = 0.006). Multiparity increased risk for depression (p = 0.001), for anxiety (p = 0.026) and for perinatal stress (p = 0.010). More than 80% of women with depressive symptoms had comorbidities of psychological distress. CONCLUSIONS Breech presentation compared to cephalic presentation was not associated with higher levels of psychological distress. However, breech pregnancies are affected by symptoms of potential mental disorder. Multiparous women and younger women may need additional support and would benefit from a standardized screening tool for the assessment of perinatal psychological distress. CLINICAL TRIAL REGISTRATION Ethical approval (EA2/241/18) was granted by the Ethics Commission of the Charité University Hospital on the 23.01.2019 (ClinicalTrials.gov Identifier: NCT03827226).
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Affiliation(s)
- Madeleine Schauer
- Department of Obstetrics, Charité Hospital, Humboldt University, Berlin, Germany
| | - Elisabetta Latartara
- Department of Obstetrics, Charité Hospital, Humboldt University, Berlin, Germany
- Università Cattolica del Sacro Cuore Largo Francesco Vito, Rome, Italy
| | - Maria Alonso-Espias
- Department of Obstetrics, Charité Hospital, Humboldt University, Berlin, Germany
- La Paz University Hospital, Madrid, Spain
| | - Emma Rossetti
- Department of Obstetrics, Charité Hospital, Humboldt University, Berlin, Germany
- University of Udine, Udine, Italy
| | - Pimrapat Gebert
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Wolfgang Henrich
- Department of Obstetrics, Charité Hospital, Humboldt University, Berlin, Germany
| | - Larry Hinkson
- Department of Obstetrics, Charité Hospital, Humboldt University, Berlin, Germany.
- , 8. Floor, Bettenhochhaus, Campus Mitte, Chariteplatz 1, 10117, Berlin, Germany.
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Bevilacqua E, Jani JC, Meli F, Carlin A, Bonanni G, Rimbault M, Ruggiano I, Quenon C, Romanzi F, Lanzone A, Badr DA. Pregnancy outcomes in breech presentation at term: a comparison between 2 third level birth center protocols. AJOG GLOBAL REPORTS 2022; 2:100086. [DOI: 10.1016/j.xagr.2022.100086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
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Fard D, Borchers CS, Philippeit JC, Philippeit AV, Kaukemüller LR, Higgins-Wood LR, Papageorgiou S, Hillemanns P, von Kaisenberg CS, Klapdor R. Comparing forces on the fetal neck in breech delivery in lithotomy versus all-fours position: a simulation model. Arch Gynecol Obstet 2022; 308:91-99. [PMID: 35857095 DOI: 10.1007/s00404-022-06671-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/14/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To measure forces applied to the fetal neck, in a simulation model for breech delivery, in both lithotomy versus all-fours position. METHODS We used a Laerdal SimMom simulator and a Birthing Baby together with PROMPT Flex Software. The descent of the fetus was accomplished using the Automatic Delivery Module 2. The baby was always in breech position; the SimMom in either all-fours or lithotomy positions. Sensors were located inside the fetal neck region to simulate forces applied to the plexus. RESULTS The lowest force on the fetal neck region was recorded for the delivery in all-fours position without further maneuvers (mean force 58.70 Newton, standard deviation 2.54 N). As weight was added to the baby, the force increased (i.e. + 500 g, mean force 71.8 N, SD 3.08 N, p < 0.001). Delivery in lithotomy position resulted in a mean force of 81.56 N (SD 19.55 N). The force significantly increased in case of delivery of the head without assistance from contractions (mean force 127.93 N, SD 23.10 N). In all-fours position, the delivery of the fetal head from pelvic floor level without contractions (Frank's Nudge maneuver) resulted in a mean force of 118.45 N (SD 15.48 N, p = 0.02). Maneuvers for shoulder dystocia (the inverted type that can occur during breech delivery) led to significantly higher mean forces independent from birthing positions. CONCLUSION Breech delivery in all-fours position was associated with the lowest force acting on the fetal neck in our simulation model.
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Affiliation(s)
- Delnaz Fard
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - Chiara S Borchers
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - Jill-Caren Philippeit
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - Anja V Philippeit
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - Laura R Kaukemüller
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - Lara R Higgins-Wood
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - Spyridon Papageorgiou
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - Peter Hillemanns
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - Constantin S von Kaisenberg
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - Rüdiger Klapdor
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany.
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Fernández-Carrasco FJ, Cristóbal-Cañadas D, Gómez-Salgado J, Vázquez-Lara JM, Rodríguez-Díaz L, Parrón-Carreño T. Maternal and fetal risks of planned vaginal breech delivery vs planned caesarean section for term breech birth: A systematic review and meta-analysis. J Glob Health 2022; 12:04055. [PMID: 35976004 PMCID: PMC9284475 DOI: 10.7189/jogh.12.04055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Breech presentation delivery approach is a controversial issue in obstetrics. How to cope with breech delivery (vaginal or C-section) has been discussed to find the safest in terms of morbidity. The aim of this study was to assess the risks of foetal and maternal mortality and perinatal morbidity associated with vaginal delivery against elective caesarean in breech presentations, as reported in observational studies. Methods Studies assessing perinatal morbidity and mortality associated with breech presentations births. Cochrane, Medline, Scopus, Embase, Web of Science, and Cuiden databases were consulted. This protocol was registered in PROSPERO CRD42020197598. Selection criteria were: years between 2010 and 2020, in English language, and full-term gestation (37-42 weeks). The methodological quality of the eligible articles was assessed according to the Newcastle-Ottawa scale. Meta-analyses were performed to study each parameter related to neonatal mortality and maternal morbidity. Results The meta-analysis included 94 285 births with breech presentation. The relative risk of perinatal mortality was 5.48 (95% confidence interval (CI) = 2.61-11.51) times higher in the vaginal delivery group, 4.12 (95% CI = 2.46-6.89) for birth trauma and 3.33 (95% CI = 1.95-5.67) for Apgar results. Maternal morbidity showed a relative risk 0.30 (95% CI = 0.13-0.67) times higher in the planned caesarean group. Conclusions An increment in the risk of perinatal mortality, birth trauma, and Apgar lower than 7 was identified in planned vaginal delivery. However, the risk of severe maternal morbidity because of complications of a planned caesarean was slightly higher.
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Affiliation(s)
- Francisco J Fernández-Carrasco
- Department of Gynaecology and Obstetrics, Punta de Europa Hospital, Cádiz, Spain
- Nursing and Physiotherapy Department, Faculty of Nursing, University of Cádiz, Algeciras, Spain
| | - Delia Cristóbal-Cañadas
- Neonatal and Paediatric Intensive Care Unit, Torrecárdenas University Hospital, Almeria, Spain
| | - Juan Gómez-Salgado
- Department of Gynaecology and Obstetrics, Ceuta University Hospital, Midwifery Teaching Unit of Ceuta, University of Granada, Ceuta, Spain
- Safety and Health Postgraduate Programme, Espíritu Santo University, Guyaquil, Ecuador
| | - Juana M Vázquez-Lara
- Department of Gynaecology and Obbstetrics, Ceuta University Hospital, Midwifery Teaching Unit of Ceuta, University of Granada, Ceuta, Spain
| | - Luciano Rodríguez-Díaz
- Department of Gynaecology and Obbstetrics, Ceuta University Hospital, Midwifery Teaching Unit of Ceuta, University of Granada, Ceuta, Spain
| | - Tesifón Parrón-Carreño
- School of Health Sciences, University of Almeria, Almeria, Spain
- Territorial Delegation of Equality, Health and Social Policies, Health Delegation of Almeria, Almeria, Spain
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Murata C, Gutiérrez-Castrellón P, Pérez-Villatoro F, García-Torres I, Enríquez-Flores S, de la Mora-de la Mora I, Fernández-Lainez C, Werner J, López-Velázquez G. Delivery mode-associated gut microbiota in the first 3 months of life in a country with high obesity rates: A descriptive study. Medicine (Baltimore) 2020; 99:e22442. [PMID: 33019428 PMCID: PMC7535699 DOI: 10.1097/md.0000000000022442] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Delivery methods during childbirth and their related gut microbiota profiles have important impacts on health later in life, they can contribute to the development of diseases such as obesity, whose highest prevalence rate is found among the Mexican child population. Coincidentally, Mexico has one of the highest global average annual rate increase in cesarean births (C-section). Since Mexico leads the world in childhood obesity, studying the relationship between childbirth delivery methods and gut microbiota profiles in this vulnerable population may be used to identify early risk factors for obesity in other developed and developing countries. The objective of this study is to determine the association between child delivery method and gut microbiota profiles in healthy Mexican newborns.Fecal samples of 57 term infants who participated in a randomized clinical trial in 2013 to study the safety of Agave fructans in newborns, were used in this study. DNA samples were extracted and used to characterize the microbiota composition using high-throughput 16S rRNA gene sequencing. The samples were further divided based on childbirth delivery method, as well as early diet. Gut microbiota profiles were determined and analyzed using cluster analysis followed by multiple correspondence analysis.An unusual high abundance of Proteobacteria was found in the gut microbiota of all Mexican infants studied, regardless of delivery method. Feces from infants born by C-section had low levels of Bacteroidetes, high levels of Firmicutes, especially Clostridium and Enterococcus, and a strikingly high ratio of Firmicutes/Bacteroidetes (F:B). Profiles enriched in Bacteroidetes and low F:B ratios, were strongly associated with vaginal delivery.The profile of gut microbiota associated with feces from Mexican infants born by C-section, may be added to the list of boosting factors for the worrying obesity epidemic in Mexico.
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Affiliation(s)
- Chiharu Murata
- Research Methodology Department. National Institute of Pediatrics, Mexico
| | | | | | | | | | | | - Cynthia Fernández-Lainez
- Laboratory of Inborn Errors of Metabolism and Screening, INP, and Postgraduate in Biological Sciences, UNAM, México. Actual Address: Immunoendocrinology, Division of Medical Biology, Department of Pathology and Medical Biology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Julieta Werner
- Indigenous Services Canada, Thunder Bay, Ontario, Canada
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Vargas S, Rego S, Clode N. Cesarean Section Rate Analysis in a Tertiary Hospital in Portugal According to Robson Ten Group Classification System. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2020; 42:310-315. [PMID: 32604433 PMCID: PMC10418145 DOI: 10.1055/s-0040-1712127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 03/23/2020] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE The Robson 10 group classification system (RTGCS) is a reproducible, clinically relevant and prospective classification system proposed by the World Health Organization (WHO) as a global standard for assessing, monitoring and comparing cesarean section (CS) rates. The purpose of the present study is to analyze CS rates according to the RTGCS over a 3-year period and to identify the main contributors to this rate. METHODS We reviewed data regarding deliveries performed from 2014 up to 2016 in a tertiary hospital in Portugal, and classified all women according to the RTGCS. We analyzed the CS rate in each group. RESULTS We included data from 6,369 deliveries. Groups 1 (n = 1,703), 2 (n = 1,229) and 3 (n = 1,382) represented 67.7% of the obstetric population. The global CS rate was 25% (n = 1,594). Groups 1, 2, 5 and 10 were responsible for 74.2% of global CS deliveries. CONCLUSION As expected, Groups 1, 2, 5 and 10 were the greatest contributors to the overall CS rate. An attempt to increase the number of vaginal deliveries in these groups, especially in Groups 2 and 5, might contribute to the reduction of the CS rate.
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Affiliation(s)
- Sara Vargas
- Departamento de Ginecologia, Obstetrícia e Medicina da Reprodução, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal
| | - Susana Rego
- Departamento de Ginecologia, Obstetrícia e Medicina da Reprodução, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal
| | - Nuno Clode
- Departamento de Ginecologia, Obstetrícia e Medicina da Reprodução, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal
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Maternal and neonatal outcome after vaginal breech delivery of nulliparous versus multiparous women of singletons at term-A prospective evaluation of the Frankfurt breech at term cohort (FRABAT). Eur J Obstet Gynecol Reprod Biol 2020; 252:583-587. [PMID: 32362353 DOI: 10.1016/j.ejogrb.2020.04.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 03/24/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The best way to deliver a term breech infant is still a much discussed topic among obstetricians. The question whether nulliparity should be considered an exclusion criterion for an intended vaginal breech delivery is not fully answered. OBJECTIVE We compared maternal and neonatal outcome of intended vaginal breech deliveries of nulliparous versus multiparous women at term. STUDY DESIGN We conducted a prospective case-control study between January 2004 and December 2016. 1046 women expecting singletons at term with favorable pelvic measurements were enrolled in the study. RESULTS Neonatal morbidity and mortality was not significantly different in deliveries of nulliparous (n = 647) versus multiparous (n = 399) women. Nulliparous women had a significantly higher rate of a cesarean section during labor than multiparous women. Maternal birth-injury rates and the use of epidural anesthesia were significantly higher comparing vaginal births of nulliparous (n = 384) versus multiparous (n = 331) women. CONCLUSION Nulliparity seems not be an exclusion criterion for intended vaginal breech birth at term. It is still important to inform the women of an increased risk of a cesarean section during labor. A clinical management built on this evidence might reduce negative implications for future pregnancies.
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Grillo-Ardila CF, Bautista-Charry AA, Diosa-Restrepo M. Breech presentation delivery care: A review of childbirth semiology, mechanism and care. REVISTA COLOMBIANA DE OBSTETRICIA Y GINECOLOGIA 2019; 70:253-265. [PMID: 32142240 DOI: 10.18597/rcog.3345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 12/27/2019] [Indexed: 11/04/2022]
Abstract
Objective To review the concepts underlying breech presentation delivery as well as the semiology and the obstetric maneuvers contributing to a successful perinatal maternal outcome. Materials and methods Based on a hypothetical scenario to set the stage for a practical approach to the topic, an explanatory paper built on a narrative review is created in order to examine the principles related to diagnosis, mechanism of delivery and maternal care, emphasizing maneuvers to ease fetal extraction. Results Breech presentation delivery must be managed through the vaginal canal when already in the expulsion phase with fetal engagement. For diagnosis and care, it is essential to know the unique semiology and physiology of this condition as well as the obstetric maneuvers to facilitate an uncomplicated delivery. Results The mechanism of childbirth in breech presentation is complex and requires knowledge of its physiology and multiple obstetric maneuvers on the part of the obstetrician as well as the general practitioner, in order to ensure adequate care when there is no other option.
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Affiliation(s)
| | | | - Mariana Diosa-Restrepo
- Residente de tercer año de Obstetricia y Ginecología, Facultad de Medicina, Universidad Nacional de Colombia
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