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The Cochrane Database of Systematic... Jul 2015External cephalic version (ECV) of the breech fetus at term (after 37 weeks) has been shown to be effective in reducing the number of breech presentations and caesarean... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
External cephalic version (ECV) of the breech fetus at term (after 37 weeks) has been shown to be effective in reducing the number of breech presentations and caesarean sections, but the rates of success are relatively low. This review examines studies initiating ECV prior to term (before 37 weeks' gestation).
OBJECTIVES
To assess the effectiveness of a policy of beginning ECV before term (before 37 weeks' gestation) for breech presentation on fetal presentation at birth, method of delivery, and the rate of preterm birth, perinatal morbidity, stillbirth or neonatal mortality.
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 March 2015) and reference lists of retrieved studies.
SELECTION CRITERIA
Randomised controlled trials (RCTs) of ECV attempted before term (37 weeks' gestation) or commenced before term, compared with a control group of women (in breech presentation) in which either no ECV attempted or ECV was attempted at term. Cluster-randomised trials were eligible for inclusion but none were identified. Quasi-RCTs or studies using a cross-over design were not eligible for inclusion.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked for accuracy. Studies were assessed for risk of bias and for important outcomes the overall quality of the evidence was assessed using the GRADE approach.
MAIN RESULTS
Five studies are included (2187 women). It was not possible for the intervention to be blinded, and it is not clear what impact lack of blinding would have on the outcomes reported. For other 'Risk of bias' domains studies were either at low or unclear risk of bias.One study reported on ECV that was undertaken and completed before 37 weeks' gestation compared with no ECV. No difference was found in the rate of non-cephalic presentation at birth (risk ratio (RR) 1.04, 95% confidence interval (CI) 0.64 to 1.69; participants = 102). One study reported on a policy of ECV that was initiated before term (33 weeks) and up until 40 weeks' gestation and which could be repeated up until delivery compared with no ECV. This study showed a decrease in the rate of non-cephalic presentation at birth (RR 0.59, 95% CI 0.45 to 0.77; participants = 179).Three studies reported on ECV started at between 34 to 35 weeks' gestation compared with beginning at 37 to 38 weeks' gestation. Pooled results suggested that early ECV reduced the risk of non-cephalic presentation at birth (RR 0.81, 95% CI 0.74 to 0.90; participants = 1906; studies = three; I² = 0%, evidence graded high quality), failure to achieve vaginal cephalic birth (RR 0.90, 95% CI 0.83 to 0.97; participants = 1888; studies = three; I² = 0%, evidence graded high quality), and vaginal breech delivery (RR 0.44, 95% CI 0.25 to 0.78; participants = 1888; studies = three; I² = 0%, evidence graded high quality). The difference between groups for risk of caesarean was not statistically significant (RR 0.92, 95% CI 0.85 to 1.00; participants = 1888; studies = three; I² = 0%, evidence graded high quality). There was evidence that risk of preterm labour was increased with early ECV compared with ECV after 37 weeks (6.6% in the ECV group and 4.3% for controls) (RR 1.51, 95% CI 1.03 to 2.21; participants = 1888; studies = three; I² = 0%, evidence graded high quality). There was no clear difference between groups for low infant Apgar score at five minutes or perinatal death (stillbirth plus neonatal mortality up to seven days) (evidence graded as low quality for both outcomes).
AUTHORS' CONCLUSIONS
Compared with no ECV attempt, ECV commenced before term reduces non-cephalic presentation at birth. Compared with ECV at term, beginning ECV at between 34 to 35 weeks may have some benefit in terms of decreasing the rate of non-cephalic presentation, and risk of vaginal breech birth. However, early ECV may increase risk of late preterm birth, and it is important that any future research reports infant morbidity outcomes. Results of the review suggest that there is a need for careful discussion with women about the timing of the ECV procedure so that they can make informed decisions.
Topics: Breech Presentation; Female; Humans; Pregnancy; Pregnancy Trimester, Third; Premature Birth; Randomized Controlled Trials as Topic; Version, Fetal
PubMed: 26222245
DOI: 10.1002/14651858.CD000084.pub3 -
American Family Physician Sep 1998External cephalic version is a procedure that externally rotates the fetus from a breech presentation to a vertex presentation. External version has made a resurgence in... (Review)
Review
External cephalic version is a procedure that externally rotates the fetus from a breech presentation to a vertex presentation. External version has made a resurgence in the past 15 years because of a strong safety record and a success rate of about 65 percent. Before the resurgence of the use of external version, the only choices for breech delivery were cesarean section or a trial of labor. It is preferable to wait until term (37 weeks of gestation) before external version is attempted because of an increased success rate and avoidance of preterm delivery if complications arise. After the fetal head is gently disengaged, the fetus is manipulated by a forward roll or back flip. If unsuccessful, the version can be reattempted at a later time. The procedure should only be performed in a facility equipped for emergency cesarean section. The use of external cephalic version can produce considerable cost savings in the management of the breech fetus at term. It is a skill easily acquired by family physicians and should be a routine part of obstetric practice.
Topics: Algorithms; Breech Presentation; Decision Making; Female; Humans; Patient Education as Topic; Patient Selection; Pregnancy; Teaching Materials; Version, Fetal
PubMed: 9750541
DOI: No ID Found -
Acta Medica Portuguesa 1999Labour is very important in breech presentation and it is associated to significant morbidity and mortality enhancement in recent years. The authors made a retrospective...
Labour is very important in breech presentation and it is associated to significant morbidity and mortality enhancement in recent years. The authors made a retrospective study of breech presentation and labour with this kind of fetal presentation, in Santa Maria Hospital in 1993 and analysed the following data: maternal age, parity, gestational age, the mode of delivery, the fetal weight, the maternal and fetal morbidity and mortality. The authors also reviewed the Literature on the incidence, the most frequent complications and the management in labour to compare with the results of the study. The authors found that the incidence of breech presentation in this hospital is slightly higher (4.7%) than the universal data. The remaining results had no significant difference.
Topics: Adolescent; Adult; Birth Weight; Breech Presentation; Delivery, Obstetric; Female; Gestational Age; Humans; Infant, Newborn; Maternal Age; Parity; Pregnancy; Retrospective Studies
PubMed: 10481320
DOI: No ID Found -
The Journal of Maternal-fetal &... Feb 2018To investigate the association between maternal age and spontaneous breech presentation. (Observational Study)
Observational Study
PURPOSE
To investigate the association between maternal age and spontaneous breech presentation.
MATERIAL AND METHODS
Fifteen-year observational study over (2001-2015). All consecutive singleton births delivered at the Centre Hospitalier Universitaire Sud Reunion's maternity. The only single exclusion criterion was uterine malformations (N = 123) women.
RESULTS
Of the 60,963 singleton births, there was a linear association (χ for linear trend, p< 0.0001) between maternal age and spontaneous breech presentation. Overall rate of breech presentation was 2.7% in deliveries over 32 weeks gestation, while it was 1.9% in women aged 15 to 19 years and 4.0% in women aged 45+, with a linear progression for each 5-year age category. This linearity remained significant controlling for early prematurity (<33 weeks) and severe fetal malformations (χ for linear trend = 64, p < 0.0001). Controlling in a multiple logistic regression model for other major risk factors gestational age, female sex, primiparity, maternal age remained significantly an independent risk factor, p < 0.0001.
CONCLUSION
Maternal age (x) is an independent factor for breech presentation in singleton pregnancies after 32 weeks gestation with a linear association that may be approximated at y = 0.1x. (y: incidence, percent).
Topics: Adolescent; Adult; Breech Presentation; Child; Female; Humans; Maternal Age; Middle Aged; Pregnancy; Retrospective Studies; Reunion; Young Adult
PubMed: 28110591
DOI: 10.1080/14767058.2017.1285897 -
BMJ (Clinical Research Ed.) Apr 2008Maternal and paternal history of breech increase risk equally
Maternal and paternal history of breech increase risk equally
Topics: Breech Presentation; Female; Humans; Male; Pedigree; Pregnancy; Recurrence; Registries; Risk Factors
PubMed: 18369203
DOI: 10.1136/bmj.39527.608542.80 -
BMC Pregnancy and Childbirth Mar 2022In many countries, vaginal breech labor at term is an option in selected cases. However, the safety of vaginal breech labor in preterm is still unclear. Therefore our...
BACKGROUND
In many countries, vaginal breech labor at term is an option in selected cases. However, the safety of vaginal breech labor in preterm is still unclear. Therefore our study aimed to evaluate the safety of vaginal breech labor in late preterm deliveries.
DESIGN
A retrospective register-based study.
SETTING
Maternity hospitals in Finland, 2004-2017.
PARTICIPANTS
The study population included 762 preterm breech deliveries at 32 + 0-36 + 6 gestational weeks according to the mode of delivery, 535 (70.2%) of them were born vaginally in breech presentation, and 227 (29.8%) were delivered by non-urgent cesarean section.
METHODS
The study compared short-term neonatal adverse outcomes of singleton vaginal breech deliveries with non-urgent cesarean deliveries at 32 + 0 to 36 + 6 weeks of gestation. An odd ratio with 95% confidence intervals was calculated to estimate the relative risk of adverse outcomes.
OUTCOME MEASURES
Neonatal death, an arterial umbilical pH below seven, a five-minute Apgar score below four and seven, admission to neonatal intensive care unit, neonatal intubation, neonatal antibiotic therapy, neonatal birth trauma, respiratory distress syndrome, neonatal convulsions, cerebral ischemia, hypoxic-ischemic encephalopathy, congenital hypotonia, and a composite of severe adverse outcomes.
RESULTS
A five-minute Apgar scores below seven were increased in vaginal breech labor at 32 + 0 to 36 + 6 weeks of gestation compared to non-urgent cesarean sections (aOR 2.48, 95% CI 1.08-5.59). Neonatal antibiotic therapy, the admission to neonatal intensive care unit, and neonatal respiratory distress syndrome were decreased after vaginal breech labor compared to the outcomes of non-urgent cesarean section (neonatal antibiotic therapy aOR 0.60, 95% CI 0.40-0.89; neonatal NICU admission aOR 0.47, 95% CI 0.33-0.68; respiratory distress syndrome aOR 0.30, 95% CI 0.19-0.48).
CONCLUSION
Vaginal breech labor at 32 + 0-36 + 6 gestational weeks does not increase severe neonatal short-term morbidity or mortality compared to cesarean section.
Topics: Breech Presentation; Cesarean Section; Delivery, Obstetric; Female; Humans; Infant, Newborn; Pregnancy; Pregnancy Outcome; Retrospective Studies
PubMed: 35296277
DOI: 10.1186/s12884-022-04547-9 -
BMC Pregnancy and Childbirth Jul 2020The incidence of breech presentation in single pregnancies at term is between three to 5 %. In order to support eligible women in their choice of mode of delivery, a... (Observational Study)
Observational Study
BACKGROUND
The incidence of breech presentation in single pregnancies at term is between three to 5 %. In order to support eligible women in their choice of mode of delivery, a dedicated breech clinic with a care pathway was developed in December 2015 in a tertiary referral centre in Brussels. The primary objective of this study was to evaluate the vaginal birth rate before and after the introduction of a dedicated breech clinic. The secondary objective was to compare the early neonatal outcomes before and after the breech clinic was introduced.
METHODS
This was a single centre retrospective and prospective study. The inclusion criteria were term (from 37 weeks), singleton fetus and breech presentation at delivery. The exclusion criteria were suspected intrauterine growth restriction, severe fetal malformations and intrauterine fetal demise. We used a composite outcome as an indicator of neonatal morbidity and mortality.
RESULTS
After the introduction of the breech clinic, we observed a significant increase in planned vaginal delivery from 7.4% (12/162) to 53.0% (61/115) (OR: 13.5; 95% CI: 6.7-27.0). The effective vaginal breech delivery rate (planned and unexpected) significantly increased from 4.3% (7/162) pre-implementation of breech clinic to 43.5% (50/115) post-implementation (OR: 17.0; 95% CI: 7.3-39.6). Neonatal outcomes were not statistically different between the before and after periods.
CONCLUSION
The introduction of a dedicated breech clinic has led to an increase in vaginal deliveries for breech babies without adversely affecting neonatal outcomes.
Topics: Adult; Apgar Score; Belgium; Breech Presentation; Cesarean Section; Delivery, Obstetric; Female; Humans; Infant; Infant Mortality; Infant, Newborn; Pregnancy; Pregnancy Outcome; Prospective Studies; Retrospective Studies; Tertiary Care Centers; Young Adult
PubMed: 32727421
DOI: 10.1186/s12884-020-03122-4 -
Journal of Personalized Medicine Jul 2023Since essential factors have changed in recent years in assisted reproduction technologies (ARTs), this study reassessed the association between ART and breech...
Since essential factors have changed in recent years in assisted reproduction technologies (ARTs), this study reassessed the association between ART and breech presentation. We primarily aimed to estimate the correlation between ART and breech at delivery. Secondary purposes were to evaluate the correlation between other subfertility treatments (OSTs) and breech and to assess possible confounding factors and temporal trends. This study investigated the 31,692,729 live birth certificates from US states and territories in the 2009-2020 period. The inclusion criteria were singleton births reporting the method of conception and the presentation at delivery. The outcome was the breech presentation at delivery, while the primary exposure was ART, the secondary exposure was OST, and the potential confounding factors from the literature were considered. ART (OR 2.32 CI.95 2.23-2.41) and OST (OR 1.79 CI.95 1.71-1.87) were independent and significant risk factors for breech at delivery ( < 0.001). This study confirmed breech presentation risk factors maternal age, nulliparity, tobacco smoke, a previous cesarean delivery (CD), neonatal female sex, gestational age, and birth weight. Black race and Hispanic origin were verified to be protective factors. We found breech prevalence among ART and OST to be stable during the study period. Meanwhile, newborn birth weight was increased, and the gap between breech and other presentations in ART was reduced. Our results indicate that singleton pregnancies conceived by ART or OST were associated with a higher risk of breech at delivery. Well-known risk factors for the breech presentation were also confirmed. Some of these factors can be modified by implementing interventions to reduce their prevalence (e.g., tobacco smoke and previous CD).
PubMed: 37511757
DOI: 10.3390/jpm13071144 -
The Cochrane Database of Systematic... Jul 2015In a vaginal breech birth there may be benefit from rapid delivery of the baby to prevent progressive acidosis. However, this needs to be weighed against the potential... (Review)
Review
BACKGROUND
In a vaginal breech birth there may be benefit from rapid delivery of the baby to prevent progressive acidosis. However, this needs to be weighed against the potential trauma of a quick delivery.
OBJECTIVES
The objective of this review was to assess the effects of expedited vaginal delivery (breech delivery from umbilicus to delivery of the head within one contraction) on perinatal outcomes.
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 May 2015) and reference lists of retrieved studies.
SELECTION CRITERIA
Randomised trials of expedited vaginal breech delivery compared with delivery not routinely expedited in women undergoing vaginal breech delivery.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed the one identified trial for inclusion.If studies are included in future updates, two review authors will assess risk of bias, extract data and check data for accuracy.
MAIN RESULTS
No studies were included.
AUTHORS' CONCLUSIONS
There is not enough evidence to evaluate the effects of expedited vaginal breech delivery.
Topics: Breech Presentation; Delivery, Obstetric; Female; Humans; Pregnancy
PubMed: 26197303
DOI: 10.1002/14651858.CD000082.pub3 -
Acta Orthopaedica Feb 2016Instability of the patellofemoral joint is a common disorder in children and young adults. Although it has multifactorial causes, a shallow femoral trochlea is the...
BACKGROUND AND PURPOSE
Instability of the patellofemoral joint is a common disorder in children and young adults. Although it has multifactorial causes, a shallow femoral trochlea is the single most important factor for instability. There is no consensus as to the etiology of trochlear dysplasia. We assessed whether the presentation of the fetus at birth could be a predisposing factor for trochlear dysplasia.
SUBJECTS AND METHODS
We examined 348 knees in 174 newborns using ultrasonography, concentrating especially on the trochlea femoris. We measured the sulcus angle (SA) on a transverse scan. The way of fetal presentation at birth and standard parameters such as sex, gestational age, and length and weight at birth were registered. As breech presentation is a known risk factor for dysplasia of the hip, we also looked for an association between dysplasia of the femoral trochlea and dysplasia of the hips.
RESULTS
The mean SA was 148°. 17 knees in 14 children had an SA of >159°, which was defined as the threshold value for dysplasia. The incidence of breech position in these children was 15-fold higher. Of the different groups of breech positions, a child in frank breech with the knees locked in extension had a 45-fold increased risk of having trochlear dysplasia.
INTERPRETATION
For some newborns, a high sulcus angle can be found at birth, indicating that trochlear dysplasia can be found from birth. Breech presentation with knees extended appears to be a major risk factor for development of trochlear dysplasia.
Topics: Adult; Breech Presentation; Female; Follow-Up Studies; Gestational Age; Humans; Incidence; Infant, Newborn; Joint Instability; Knee Joint; Linear Models; Neonatal Screening; Norway; Odds Ratio; Patellofemoral Joint; Pregnancy; Registries; Retrospective Studies; Risk Assessment; Ultrasonography
PubMed: 26381593
DOI: 10.3109/17453674.2015.1089023