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Tidsskrift For Den Norske Laegeforening... Feb 2001
Topics: Breech Presentation; Female; Humans; Practice Guidelines as Topic; Pregnancy; Randomized Controlled Trials as Topic
PubMed: 11255849
DOI: No ID Found -
BMJ Case Reports Oct 2020We report a case of idiopathic spontaneous intraperitoneal haemorrhage (ISIH) in a 31-year-old patient at 37 weeks gestation in her second pregnancy. The patient...
We report a case of idiopathic spontaneous intraperitoneal haemorrhage (ISIH) in a 31-year-old patient at 37 weeks gestation in her second pregnancy. The patient presented to the labour ward with abdominal pain and uterine contractions. The initial complain was of sudden onset, severe sharp pain in left iliac fossa. She started having uterine contractions within 30 min of her presentation. Examination confirmed early labour with a footling breech presentation. Urgent caesarean section was performed that confirmed peritoneal bleeding of unknown origin with safe delivery of the baby. Mother and baby were safely discharged on day 5. 'Abdominal apoplexy' (ISIH), is a rare obstetric emergency with increased risk of fetal and maternal morbidity and mortality. With various clinical presentations as a possibility, diagnosis is challenging. High index of suspicion with prompt management of suspected cases can be pivotal life saving measure for the fetus and mother.
Topics: Adult; Breech Presentation; Female; Hemoperitoneum; Humans; Laparotomy; Pregnancy; Uterine Rupture
PubMed: 33127691
DOI: 10.1136/bcr-2020-235946 -
Turning Foetal Breech Presentation at 32-35 Weeks of Gestational Age by Acupuncture and Moxibustion.Evidence-based Complementary and... 2019Foetal breech presentation is an obstetric problem that often leads to caesarean section. Stimulation of the acupoint BL67 by moxibustion may correct breech presentation.
INTRODUCTION
Foetal breech presentation is an obstetric problem that often leads to caesarean section. Stimulation of the acupoint BL67 by moxibustion may correct breech presentation.
METHODS
We observed 93 pregnant women in the 32nd-35th week of gestation with normal pregnancy and ultrasound diagnosis of breech presentation. The patients received stimulation of acupoint BL67 by self-administered moxibustion once a day for two weeks and if foetuses still were in breech presentation, moxibustion, and needle in the points BL65 and SI1, lasting 30 minutes, for three days in one week. The main outcome was vaginal birth with vertex presentation at delivery; the secondary outcome was compliance in the self-administration of the moxibustion treatment.
RESULTS
We observed cephalic version and natural childbirth in 62.4% of all treated women. The treatment was accepted by 98.9% women (93/94), and compliance was 91.4% (85/93) for self-administered moxibustion and 37.5% (12/32) for moxibustion and needle treatment.
CONCLUSIONS
On the basis of our results, self-administered home treatment moxibustion followed by moxibustion and needle stimulations may be an effective and low-cost treatment for inducing cephalic version.
PubMed: 31281404
DOI: 10.1155/2019/8950924 -
BMC Musculoskeletal Disorders Jan 2022The relationship between breech presentation and trochlear dysplasia has been confirmed. However, the pathological process of breech-related trochlear dysplasia remains...
BACKGROUND
The relationship between breech presentation and trochlear dysplasia has been confirmed. However, the pathological process of breech-related trochlear dysplasia remains unclear. This study aimed to establish an animal model to simulate breech presentation and to analyze the pathological process of the femoral trochlea.
MATERIALS AND METHODS
One hundred and twenty neonatal rats were randomly assigned into a control group and two experimental groups that were swaddled (using surgical tape) to keep the hip flexed and knees extended to simulate human breech presentation for the 5 days (short Swaddling) and the 10 days (prolonged Swaddling) of life. Gross and cross-sectional observation, histological staining measurement in two experimental time points (5 and 10 days after birth) were conducted to evaluate the morphological changes of the femoral trochlea.
RESULTS
The incidence of trochlear dysplasia increased with the Swaddling time. Rats in the prolonged Swaddling group had the high prevalence of trochlea dysplasia (52 of 60), followed by short Swaddling group (42 of 60). Gross and cross-sectional observation showed a shallower trochlea groove in two experimental groups. Histologicalstaining measurement indicated that the trochlear sulcus angle and trochlear sulcus depth were significantly different between the experimental group and the control group since day 5 and day 10.
CONCLUSION
In this model, breech presentation had an adverse effect on neonatal knees and could induce trochlear dysplasia. In addition, this study also showed that the more time in breech presentation, the more incidence of trochlear dysplasia.
Topics: Animals; Animals, Newborn; Breech Presentation; Cross-Sectional Studies; Female; Femur; Joint Instability; Pregnancy; Rats
PubMed: 35039030
DOI: 10.1186/s12891-022-05023-3 -
RoFo : Fortschritte Auf Dem Gebiete Der... May 2019Antepartal MR pelvimetry is used to assess the viability of vaginal breech delivery. We evaluated the reliability of MR pelvimetric measurements as well as incidental...
PURPOSE
Antepartal MR pelvimetry is used to assess the viability of vaginal breech delivery. We evaluated the reliability of MR pelvimetric measurements as well as incidental findings noted by different clinicians and assessed potential reference values.
METHODS
In this monocentric study, the radiologic database was searched for obstetric MR pelvimetries with singleton breech pregnancies between 1999 and 2016. 99 consecutive MR pelvimetries were included. A structured, independent review was performed by six observers with three clinical experience levels (attending, fellow, junior resident from the departments of radiology and obstetrics). Image analysis entailed the quantitative assessment of conjugata vera (CV) and diameter transversalis (DT), image quality and incidental findings. Obstetric data was retrieved from the obstetric database for reference value assessment.
RESULTS
Interobserver agreement was strong throughout (mean intraclass correlation coefficient range: 0.889 - 0.968). The individual measuring biases ranged between 0 - 2 mm, and the average limits of agreement were ± 3 mm. Regarding the mode of delivery, the recommended cesarean section (rCS) group showed significantly smaller CV measurements (CV: 11.37 ± 0.73, p-value < 0.0001) than any other delivery group. No statistical difference in CV between the vaginal delivery and unplanned cesarean section groups was found (p-value 0.902). DT measurements only showed a significant difference between rCS and elective cesarean section (p-value 0.039). 134 incidental findings were noted.
CONCLUSION
Strong interobserver agreement irrespective of the reader's experience level supports MR pelvimetry as a reliable method for identifying women with fetopelvic disproportion in breech presentation. For a comprehensive appraisal of incidental findings, radiologic expertise is vital.
KEY POINTS
· MR pelvimetry is a reliable method irrespective of the reader's experience level.. · Conjugata vera measurements aid in the prepartal viability assessment of vaginal breech delivery.. · Incidental findings are relatively common..
CITATION FORMAT
· von Bismarck A, Ertl-Wagner B, Stöcklein S et al. MR Pelvimetry for Breech Presentation at Term- Interobserver Reliability, Incidental Findings and Reference Values. Fortschr Röntgenstr 2019; 191: 424 - 432.
Topics: Adult; Breech Presentation; Delivery, Obstetric; Female; Germany; Humans; Incidental Findings; Infant, Newborn; Magnetic Resonance Imaging; Observer Variation; Pelvimetry; Pregnancy; Version, Fetal
PubMed: 30231276
DOI: 10.1055/a-0715-2122 -
European Journal of Obstetrics,... May 2022The aim of this study was to examine the association between delivery mode and severe maternal and neonatal morbidity in singleton term breech births.
OBJECTIVE
The aim of this study was to examine the association between delivery mode and severe maternal and neonatal morbidity in singleton term breech births.
STUDY DESIGN
This nationwide population-based cohort study includes 41 319 singleton term and post-term breech births (37 + 0-42 + 6 gestational weeks) in Sweden from 1998 to 2016. Data was retrieved from the Swedish Medical Birth Register. The primary outcomes were two separate composite outcomes, maternal and neonatal severe morbidity. Secondary outcomes were separate severe maternal and neonatal morbidity outcomes. Hospitalization and out-patient visits during childhood were also analyzed in ages 0-5 years. Logistic regression was used to estimate unadjusted and adjusted odds ratios (aOR) with 95% confidence intervals (CI) of severe maternal and neonatal morbidity in women with vaginal breech birth or intrapartum cesarean section. Women with a prelabor breech cesarean section was used as the reference group.
RESULTS
No difference between vaginal delivery and prelabor cesarean section was seen regarding maternal morbidity. Intrapartum cesarean section was associated with elevated odds for maternal morbidity (aOR 1.27, 95% CI 1.10-1.47) compared with prelabor cesarean section. A similar result was observed for vaginal delivery and intrapartum cesarean section combined (aOR 1.29, 95% CI 1.11-1.50). Vaginal delivery was associated with higher odds for composite neonatal morbidity (aOR 1.85, CI 1.54-2.21) and most separate outcomes, as well as increased number of hospital nights and out-patient visits during first year of life, compared with prelabor cesarean section.
CONCLUSIONS
Prelabor cesarean section in breech births improved short-term neonatal health without increasing risks for severe maternal short-term complications.
Topics: Breech Presentation; Cesarean Section; Child, Preschool; Cohort Studies; Delivery, Obstetric; Female; Humans; Infant; Infant, Newborn; Morbidity; Pregnancy
PubMed: 35325690
DOI: 10.1016/j.ejogrb.2022.03.014 -
International Journal of Gynaecology... May 2021To evaluate obstetrician/gynecologist and midwife perspectives and experiences with vaginal breech deliveries in Ghana.
OBJECTIVE
To evaluate obstetrician/gynecologist and midwife perspectives and experiences with vaginal breech deliveries in Ghana.
METHODS
Respondents completed a survey on their experiences, training, comfort levels, and decision making about vaginal breech deliveries. Comparisons were made across obstetricians/gynecologists and midwives. Multiple logistic regression explored predictors of comfort performing vaginal breech deliveries.
RESULTS
Respondents comprised 93 (36.5%) obstetricians/gynecologists and 162 (63.5%) midwives. Most believed that some breech fetuses should be delivered vaginally, with higher agreement from obstetricians/gynecologists than from midwives (n = 86, 97.7% versus n = 207, 80.8%, P = 0.001). Midwives were more likely to strongly agree that training was adequate for obstetricians/gynecologists (n = 65, 55.6% versus n = 8, 9.8%, P < 0.001) and midwives (n = 60, 49.6% versus n = 6, 7.4%, P < 0.001). Most (n = 192, 94%) respondents wanted more experience and/or training. Despite most providers performing only one ot five breech vaginal deliveries yearly, 77.4% (n = 199) were comfortable performing them and 79.5% (n = 202) were comfortable supervising them. Significant predictors of comfort performing vaginal breech delivery were perceived adequacy of training (odds ratio 8.74, 95% CI 3.39-22.52) and belief that vaginal breech deliveries should be performed (odds ratio 4.28, 95% CI 1.33-13.72).
CONCLUSION
Respondents were more likely to feel comfortable performing breech vaginal deliveries if they felt that their training was adequate. Vaginal breech deliveries can only be offered as safe alternatives to cesarean delivery if training and experience are maintained in low-resource settings.
Topics: Adult; Attitude of Health Personnel; Breech Presentation; Delivery, Obstetric; Female; Ghana; Humans; Infant, Newborn; Midwifery; Obstetrics; Pregnancy; Surveys and Questionnaires
PubMed: 33188705
DOI: 10.1002/ijgo.13478 -
Medicina (Kaunas, Lithuania) Nov 2022: In recent years, the rate of caesarean section (CS) has increased constantly. Although vaginal breech delivery has a long history, breech presentation has become the... (Observational Study)
Observational Study
: In recent years, the rate of caesarean section (CS) has increased constantly. Although vaginal breech delivery has a long history, breech presentation has become the third most common indication for CS. This study aims to identify factors associated with the success of external cephalic version (ECV), underline the success rate of ECV for breech presentation and highlight the high rate of vaginal delivery after successful ECV. : This retrospective observational study included 113 patients with singleton fetuses in breech presentation, who underwent ECV from January 2016 to March 2021 in the Clinic of Obstetrics and Gynecology, Diakonieklinikum Schwäbisch Hall, Germany. Maternal and fetal parameters and data related to procedure and delivery were collected. Possible predictors of successful ECV were evaluated. : The success rate of ECV was 54.9%. The overall rate of vaginal birth was 44.2%, regardless of ECV outcome. The vaginal birth rate after successful ECV was 80.6%. Overall, 79.0% of women with successful ECV delivered spontaneously without complications, 19.4% delivered through CS performed during labor by medical necessity, and 1.6% delivered through vacuum extraction. ECV was performed successfully in three of the four women with history of CS. Gravidity, parity, maternal age, gestational age, fetal weight, and amniotic fluid index (AFI) were significantly correlated with the outcome of ECV. : ECV for breech presentation is a safe procedure with a good success rate, thus increasing the proportion of vaginal births. Maternal and fetal parameters can be used to estimate the chances of successful ECV.
Topics: Humans; Female; Pregnancy; Version, Fetal; Breech Presentation; Cesarean Section; Delivery, Obstetric; Retrospective Studies
PubMed: 36363576
DOI: 10.3390/medicina58111619 -
Archives of Gynecology and Obstetrics Feb 2023This study aims to evaluate the level of psychological distress for women with breech compared to cephalic presentation. We hypothesized, that women with breech... (Clinical Trial)
Clinical Trial
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).
Topics: Female; Humans; Pregnancy; Anxiety; Breech Presentation; Cross-Sectional Studies; Depression; Version, Fetal
PubMed: 35344082
DOI: 10.1007/s00404-022-06509-0 -
Osteoporosis International : a Journal... Oct 2018We compared bone outcomes in children with breech and cephalic presentation at delivery. Neonatal whole-body bone mineral content (BMC) and area were lower in children...
UNLABELLED
We compared bone outcomes in children with breech and cephalic presentation at delivery. Neonatal whole-body bone mineral content (BMC) and area were lower in children with breech presentation. At 4 years, no differences in whole-body or spine measures were found, but hip BMC and area were lower after breech presentation.
INTRODUCTION
Breech presentation is associated with altered joint shape and hip dysplasias, but effects on bone mineral content (BMC), area (BA) and density (BMD) are unknown.
METHODS
In the prospective Southampton Women's Survey mother-offspring cohort, whole-body bone outcomes were measured using dual-energy X-ray absorptiometry (DXA) in 1430 offspring, as neonates (mean age 6 days, n = 965, 39 with a breech presentation at birth) and/or at age 4.1 years (n = 999, 39 breech). Hip and spine bone outcomes were also measured at age 4 years.
RESULTS
Neonates with breech presentation had 4.2 g lower whole-body BMC (95% CI -7.4 to - 0.9 g, P = 0.012) and 5.9 cm lower BA (- 10.8 to - 1.0 cm, P = 0.019), but BMD was similar between groups (mean difference - 0.007, - 0.016 to 0.002 g/cm, P = 0.146) adjusting for sex, maternal smoking, gestational diabetes, mode of delivery, social class, parity, ethnicity, age at scan, birthweight, gestational age and crown-heel length. There were no associations between breech presentation and whole-body outcomes at age 4 years, but, in similarly adjusted models, regional DXA (not available in infants) showed that breech presentation was associated with lower hip BMC (- 0.51, - 0.98 to - 0.04 g, P = 0.034) and BA (- 0.67, - 1.28 to - 0.07 cm, P = 0.03) but not with BMD (- 0.009, - 0.029 to 0.012 g, P = 0.408), or spine outcomes.
CONCLUSIONS
These results suggest that breech presentation is associated with lower neonatal whole-body BMC and BA, which may relate to altered prenatal loading in babies occupying a breech position; these differences did not persist into later childhood. Modest differences in 4-year hip BMC and BA require further investigation.
Topics: Absorptiometry, Photon; Adult; Bone Density; Breech Presentation; Female; Follow-Up Studies; Health Surveys; Hip Joint; Humans; Infant, Newborn; Osteoporosis; Pregnancy; Prospective Studies
PubMed: 30003305
DOI: 10.1007/s00198-018-4626-2