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Breech Presentation

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1. Breech presentation

Breech presentation Breech presentation - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Search Select language Breech presentation Last reviewed: December 2019 Last updated: March 2019 Summary Refers to the baby presenting for delivery with the buttocks or feet first rather than head. Associated with increased morbidity and mortality for the mother in terms of emergency caesarean section and placenta praevia (...) presentation at term. Definition Breech presentation in pregnancy occurs when a baby presents with the buttocks or feet rather than the head first (cephalic presentation) and is associated with increased morbidity and mortality for both the mother and the baby. Cunningham F, Gant N, Leveno K, et al. Williams obstetrics. 21st ed. New York: McGraw-Hill; 1997. Kish K, Collea JV. Malpresentation and cord prolapse. In: DeCherney AH, Nathan L, eds. Current obstetric and gynecologic diagnosis and treatment. New

2019 BMJ Best Practice

2. Management of Breech Presentation at Term

Management of Breech Presentation at Term No. 384-Management of Breech Presentation at Term - Journal of Obstetrics and Gynaecology Canada Email/Username: Password: Remember me Search Terms Search within Search Volume 41, Issue 8, Pages 1193–1205 No. 384-Management of Breech Presentation at Term x Andrew Kotaska , MD Yellowknife, NT x Savas Menticoglou , MD Winnipeg, MB No. 384, August 2019 (Replaces No. 226, June 2009)This guideline is the fourth in a 4-part series on labour and delivery. DOI (...) in vaginal breech birth and compared with the 2017 Royal College of Obstetricians and Gynaecologists Green Top Guideline 20b: Management of Breech Presentation. The content and recommendations were drafted and agreed upon by the principal authors. The Board of the Society of Obstetricians and Gynaecologists of Canada approved the final draft for publication. The quality of evidence was rated using the criteria described in the Grading of Recommendations Assessment, Development and Evaluation (GRADE

2019 Society of Obstetricians and Gynaecologists of Canada

3. Breech presentation

Breech presentation Breech presentation - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Breech presentation Last reviewed: February 2019 Last updated: March 2019 Summary Refers to the baby presenting for delivery with the buttocks or feet first rather than head. Associated with increased morbidity and mortality for the mother in terms of emergency caesarean section and placenta praevia; and for the baby in terms (...) of preterm birth, small fetal size, congenital anomalies, and perinatal mortality. Incidence decreases as pregnancy progresses and by term occurs in 3% to 4% of singleton term pregnancies. Treatment options include external cephalic version to increase the likelihood of vaginal birth or a planned caesarean section, the optimal gestation being 37 and 39 weeks, respectively. Planned caesarean section is considered the safest form of delivery for infants with a persisting breech presentation at term

2018 BMJ Best Practice

5. External Cephalic Version and Reducing the Incidence of Term Breech Presentation Full Text available with Trip Pro

External Cephalic Version and Reducing the Incidence of Term Breech Presentation External Cephalic Version and Reducing the Incidence of Term Breech Presentation - 2017 - BJOG: An International Journal of Obstetrics & Gynaecology - Wiley Online Library

2017 Royal College of Obstetricians and Gynaecologists

6. Management of Breech Presentation Full Text available with Trip Pro

Management of Breech Presentation Management of Breech Presentation - 2017 - BJOG: An International Journal of Obstetrics & Gynaecology - Wiley Online Library

2017 Royal College of Obstetricians and Gynaecologists

7. Expedited versus conservative approaches for vaginal delivery in breech presentation. Full Text available with Trip Pro

Expedited versus conservative approaches for vaginal delivery in breech presentation. 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.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.We searched the Cochrane (...) Pregnancy and Childbirth Group's Trials Register (31 May 2015) and reference lists of retrieved studies.Randomised trials of expedited vaginal breech delivery compared with delivery not routinely expedited in women undergoing vaginal breech delivery.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.No studies were included.There is not enough

2015 Cochrane

8. Anesthesia efficacy of bupivacaine in pregnant participants with breech presentation receiving external cephalic version: A protocol of systematic review of randomized controlled trials. Full Text available with Trip Pro

Anesthesia efficacy of bupivacaine in pregnant participants with breech presentation receiving external cephalic version: A protocol of systematic review of randomized controlled trials. The objective of this study is to appraise the efficacy and safety of bupivacaine in pregnant participants with breech presentation (BP) receiving external cephalic version (ECV).The following electronic databases will be searched from the origin to the January 31, 2020: PUBMED, EMBASE, Cochrane Library, CINAHL (...) may present important guidance for patients, clinical practice, as well as health-policy makers regarding the utilization of bupivacaine for pain relief in pregnant participants with BP receiving ECV.PROSPERO CRD42020164409.

2020 Medicine

10. Finding the breech: Influence of breech presentation on mode of delivery based on timing of diagnosis, attempt at external cephalic version, and provider success with version. (Abstract)

Finding the breech: Influence of breech presentation on mode of delivery based on timing of diagnosis, attempt at external cephalic version, and provider success with version. Breech presentation affects 3-4% of pregnancies at term and malpresentation is the primary indication for 10-15% of cesarean deliveries. External cephalic version is an effective intervention that can decrease the need for cesarean delivery; however, timely identification of breech presentation is required. We (...) hypothesized that women with a fetus in a breech presentation that is diagnosed after 38 weeks' estimated gestational age have a decreased likelihood of external cephalic version attempted and an increased likelihood of cesarean delivery.This was a retrospective cohort study. A chart review was performed for 251 women with breech presentation at term presenting to our tertiary referral university hospital for external cephalic version, cesarean for breech presentation, or vaginal breech delivery.Vaginal

2017 Birth

11. Breech delivery and external cephalic version

. Correspondence: Lone Krebs, lone.krebs@dadlnet.dk Summary of clinical recommendations: External cephalic version (ECV) Level Women with a singleton fetus in breech presentation should be offered ECV A ECV is not recommended prior to 36 weeks of gestation A The woman should be thoroughly informed about the procedure including the associated risks and discomfort B Absolute contraindications to ECV are placenta previa, placental abruption, severe preeclampsia/HELLP, abnormal CTG/Doppler flow C/D Relative (...) if attempting VD in a subsequent pregnancy B Women with CD has a risk of abnormal invasive placenta of 1/1000 in a following pregnancy B Women with CD has a 25% risk of CD in the following pregnancy B Evaluation prior to intended vaginal breech delivery Vaginal delivery is not recommended in case off: Level IUGR (> -22% , >2 SD) Consensus Deflexed neck, umbilical cord presentation or footling presentation assessed during delivery C Estimated fetal weight >4000 g by ultrasound C Regarding preterm breech

2020 Nordic Federation of Societies of Obstetrics and Gynecology

12. Breech presentation is associated with lower adolescent tibial bone strength. (Abstract)

Breech presentation is associated with lower adolescent tibial bone strength. We compared bone outcomes in adolescents with breech and cephalic presentation. Tibia bone mineral content, density, periosteal circumference, and cross-sectional moment of inertia were lower in breech presentation, and females with breech presentation had lower hip CSA. These findings suggest that prenatal loading may exert long-lasting influences on skeletal development.Breech position during pregnancy is associated (...) with reduced range of fetal movement, and with lower limb joint stresses. Breech presentation at birth is associated with lower neonatal bone mineral content (BMC) and area, but it is unknown whether these associations persist into later life.We examined associations between presentation at onset of labor, and tibia and hip bone outcomes at age 17 years in 1971 participants (1062 females) from a UK prospective birth cohort that recruited > 15,000 pregnant women in 1991-1992. Cortical BMC, cross-sectional

2019 Osteoporosis International

13. Sextuple rings of nuchal cord by breech presentation: a warning sign. (Abstract)

Sextuple rings of nuchal cord by breech presentation: a warning sign. A 30-year primigravida presented at 35 weeks and 5 days gestation with persistent breech for external cephalic version (ECV). Systematic ultrasound examination showed a normally grown fetus with extreme looping of nuchal cord (NC) around the fetal neck with head hyperextension (Fig. a and b). On 3D ultrasound there was an impression of "tribal neck rings" (Fig. c). No free umbilical cord was seen in the amniotic fluid. ECV (...) was not performed. At 37 weeks gestation the patient had reduced fetal movements. Fetal doppler showed normal resistance index (RI) of the umbilical (RI 0.56) and middle cerebral (RI 0.73) arteries. Cardiotocogram and amniotic fluid index (14.2) were normal. The fetal head was not mobile on palpation. On ultrasound, the fetal neck with six NC loops appeared anchored to the placenta on the upper posterior uterine wall. The breech was not engaged in the pelvis. The mother declined conservative management

2019 Ultrasound in Obstetrics and Gynecology

14. Turning Foetal Breech Presentation at 32-35 Weeks of Gestational Age by Acupuncture and Moxibustion. Full Text available with Trip Pro

Turning Foetal Breech Presentation at 32-35 Weeks of Gestational Age by Acupuncture and Moxibustion. Foetal breech presentation is an obstetric problem that often leads to caesarean section. Stimulation of the acupoint BL67 by moxibustion may correct breech presentation.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.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

2019 Evidence-based Complementary and Alternative Medicine (eCAM)

15. Evaluation of the effectiveness of transcutaneous nerve stimulation during labor in breech presentation: a case series. (Abstract)

Evaluation of the effectiveness of transcutaneous nerve stimulation during labor in breech presentation: a case series. To analyze the effectiveness of pain relief with transcutaneous electrical nerve stimulation (TENS) dispositive during labor in breech vaginal delivery and also to describe its tolerance and satisfaction.A randomized, double-blind, and placebo-controlled trial was conducted.Labor room of Complejo Hospitalario Universitario Insular-Materno Infantil (Spain).Ten women who met (...) the inclusion criteria of the clinical trial and also had a fetus breech presentation were randomly assigned to three groups.A portable TENS, Cefar Rehab 2pro®, unit was used to apply the experimental intervention, with different doses in the three groups in women during labor. The device intensity (amplitude) was individually adjusted to each participant's maximum sensory level. The pain was evaluated with visual analog scale (VAS). COMFORTS scale was used to measure women's satisfaction.A significant

2019 The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians Controlled trial quality: predicted high

16. Is induction of labor a reasonable option for breech presentation? (Abstract)

Is induction of labor a reasonable option for breech presentation? Whereas spontaneous onset of labor and vaginal delivery for breech presentation is considered to be a safe and effective option in selected cases, the safety of induction of labor is not established yet. The objectives of this study were to describe the outcomes of pregnancy in women induced with a fetus in breech presentation and compare the outcomes with those undergoing planned cesarean delivery.We performed a secondary (...) group.Induction of labor for breech presentation does not seem to increase neonatal mortality or severe neonatal morbidity compared with planned cesarean delivery.© 2019 Nordic Federation of Societies of Obstetrics and Gynecology.

2019 Acta Obstetricia et Gynecologica Scandinavica

17. Effect of Intrathecal Bupivacaine Dose on the Success of External Cephalic Version for Breech Presentation: A Prospective, Randomized, Blinded Clinical Trial (Abstract)

Effect of Intrathecal Bupivacaine Dose on the Success of External Cephalic Version for Breech Presentation: A Prospective, Randomized, Blinded Clinical Trial Breech presentation is a leading cause of cesarean delivery. The use of neuraxial anesthesia increases the success rate of external cephalic version procedures for breech presentation and reduces cesarean delivery rates for fetal malpresentation. Meta-analysis suggests that higher-dose neuraxial techniques increase external cephalic (...) version success to a greater extent than lower-dose techniques, but no randomized study has evaluated the dose-response effect. We hypothesized that increasing the intrathecal bupivacaine dose would be associated with increased external cephalic version success.We conducted a randomized, double-blind trial to assess the effect of four intrathecal bupivacaine doses (2.5, 5.0, 7.5, 10.0 mg) combined with fentanyl 15 μg on the success rate of external cephalic version for breech presentation. Secondary

2017 EvidenceUpdates

18. Screening for breech presentation using universal late-pregnancy ultrasonography: A prospective cohort study and cost effectiveness analysis. Full Text available with Trip Pro

Screening for breech presentation using universal late-pregnancy ultrasonography: A prospective cohort study and cost effectiveness analysis. Despite the relative ease with which breech presentation can be identified through ultrasound screening, the assessment of foetal presentation at term is often based on clinical examination only. Due to limitations in this approach, many women present in labour with an undiagnosed breech presentation, with increased risk of foetal morbidity and mortality (...) . This study sought to determine the cost effectiveness of universal ultrasound scanning for breech presentation near term (36 weeks of gestational age [wkGA]) in nulliparous women.The Pregnancy Outcome Prediction (POP) study was a prospective cohort study between January 14, 2008 and July 31, 2012, including 3,879 nulliparous women who attended for a research screening ultrasound examination at 36 wkGA. Foetal presentation was assessed and compared for the groups with and without a clinically indicated

2019 PLoS medicine

19. Prediction of Success in External Cephalic Version for Breech Presentation at Term. (Abstract)

Prediction of Success in External Cephalic Version for Breech Presentation at Term. To design a clinically based predictive model for the likelihood of successful external cephalic version (ECV).This single-center retrospective study was conducted from February 2016 to July 2018 and included all candidates for ECV between 36 and 41 weeks of gestation. Variables with a potential effect on ECV success were collected. These variables include: body mass index, amniotic fluid index, gestational age (...) , parity, location of placenta, fetal trunk posture, time in breech presentation before the procedure and the ultrasonographically measured size of the amniotic fluid preceding the fetal presenting part (fore-bag). Variables' association with ECV success was evaluated using a multivariate logistic regression and a decision tree predicting ECV outcome was developed using 75% of the patients and validated on the remaining 25%.Overall, 250 pregnant women were identified and opted for a trial of ECV

2019 Obstetrics and Gynecology

20. Expedited versus conservative approaches for vaginal delivery in breech presentation. (Abstract)

Expedited versus conservative approaches for vaginal delivery in breech presentation. 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.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.We searched the Cochrane (...) Pregnancy and Childbirth Group's Trials Register (2 February 2012).Randomised trials of expedited vaginal breech delivery compared with delivery not routinely expedited in women undergoing vaginal breech delivery.Eligibility and trial quality were assessed by one reviewer.No studies were included.There is not enough evidence to evaluate the effects of expedited vaginal breech delivery.

2012 Cochrane

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