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Breech Delivery

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41. Morbidity and mortality associated with mode of delivery for breech periviable deliveries. (PubMed)

Morbidity and mortality associated with mode of delivery for breech periviable deliveries. The purpose of this study was to estimate the odds of morbidity and death that are associated with cesarean delivery, compared with vaginal delivery, for breech fetuses who are delivered from 23-24 6/7 weeks' gestational age.We conducted a retrospective cohort study of state-level maternal and infant hospital discharge data that were linked to vital statistics for breech deliveries that occurred from 23 (...) -24 6/7 weeks' gestation in California, Missouri, and Pennsylvania from 2000-2009 (N = 1854). Analyses were stratified by gestational age (23-23 6/7 vs 24-24 6/7 weeks' gestation).Cesarean delivery was performed for 46% (335 fetuses) and 77% (856 fetuses) of 23- and 24-week breech fetuses. In multivariable analyses, overall survival was greater for cesarean-born neonates (adjusted odds ratio [AOR], 3.98; 95% confidence interval [CI], 2.24-7.06; AOR, 2.91; 95% CI, 1.76-4.81, respectively). When

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2015 American Journal of Obstetrics and Gynecology

42. Vaginal delivery versus caesarean section in preterm breech delivery: a systematic review. (PubMed)

Vaginal delivery versus caesarean section in preterm breech delivery: a systematic review. There is controversy on the preferred mode of delivery (vaginal delivery (VD) versus caesarean section (CS)) in preterm breech delivery in relation to neonatal outcome. While CS is supposed to be safer for the fetus, arguments against CS can be the increased risk of maternal morbidity, risks for future pregnancies, and costs. Moreover, neonatal respiratory distress syndrome occurs more frequently after CS (...) compared to VD. In the past, several RCTs have been started on this subject, but they were all preliminary and stopped due to recruitment difficulties. As the Cochrane review of these RCT's reported on 116 women only, knowledge on the effectiveness of CS and VD can at present only be obtained from non-randomized studies. We performed a systematic review and meta-analysis of non-randomized studies that assessed the association between mode of delivery and neonatal mortality in women with preterm breech

2014 European journal of obstetrics, gynecology, and reproductive biology

43. Breech presentation is associated with lower bone mass and area: findings from the Southampton Women's Survey. (PubMed)

Breech presentation is associated with lower bone mass and area: findings from the Southampton Women's Survey. 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.Breech presentation is associated with altered joint shape (...)  g lower whole-body BMC (95% CI -7.4 to - 0.9 g, P = 0.012) and 5.9 cm2 lower BA (- 10.8 to - 1.0 cm2, P = 0.019), but BMD was similar between groups (mean difference - 0.007, - 0.016 to 0.002 g/cm2, 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

2018 Osteoporosis International

44. A Simulator for Breech Extraction of the Second Twin. (PubMed)

A Simulator for Breech Extraction of the Second Twin. Breech extraction of a second twin is a skill useful for any health care provider planning on undertaking vaginal delivery of twins. However, training opportunities in this skill may be limited.Using readily available supplies, a reusable model neoprene uterus can be constructed, as can a balloon model to simulate a fetus in the amniotic cavity.The model allowed demonstration of skills expected of trainees and is easy to construct (...) . A simulated vagina addition increased extraction difficulty and increased the probability of balloon (amniotic sac) rupture during simulation. A hysterotomy addition enhanced model applicability for use at simulated cesarean delivery of the breech fetus.This educational device for simulation of breech extraction realistically simulates a fetus suspended in an amniotic cavity and challenges learners to use tactile cues for prompt and proper identification, grasping, and delivery of the fetal foot or feet.

2018 Obstetrics and Gynecology

45. The Difficult Delivery: Breech Presentation

The Difficult Delivery: Breech Presentation The Difficult Delivery: Breech Presentation - First10EM Search The Difficult Delivery: Breech Presentation by | Published - Updated Case A 34 year old woman G5P4 at 39 weeks gestation is wheeled into your department, and your nurses tell you to get ready: she is crowning! You examine the patient, and sure enough she appears to be crowning, but something looks funny. That is a weird looking head. Oh wait, its a bum! How to you deal with a breech (...) delivery? My approach to breech delivery Call for help: Obstetrics and pediatrics STAT. Have a team member . Management of breech presentation is going to vary a great deal depending on your resources. At my main hospital, I have 24 hour obstetrics coverage, so for me this should end at “call for OBS”. I shouldn’t do anything. But occasionally I work elsewhere, so let’s review what to do if you don’t have access to an obstetrician: As much as possible keep your hands off the patient. This allows

2015 First10EM

46. Commentary on 'A multicentre randomised controlled trial comparing elective and selective caesarean section for the delivery of the preterm breech infant'. (PubMed)

Commentary on 'A multicentre randomised controlled trial comparing elective and selective caesarean section for the delivery of the preterm breech infant'. 25488089 2015 02 20 2018 12 02 1471-0528 121 Suppl 7 2014 Dec BJOG : an international journal of obstetrics and gynaecology BJOG Commentary on 'A multicentre randomised controlled trial comparing elective and selective caesarean section for the delivery of the preterm breech infant'. 54-7 10.1111/1471-0528.13155 Hezelgrave Nl N Division (...) of Women's Health, King's College, London, UK. Anderson-Knight H H Webster L L Shennan Ah A eng Journal Article Comment England BJOG 100935741 1470-0328 AIM IM BJOG. 2014 Dec;121 Suppl 7:48-53 25488088 Breech Presentation Cesarean Section Delivery, Obstetric Female Humans Obstetric Labor, Premature Pregnancy 2014 09 11 2014 12 10 6 0 2014 12 10 6 0 2015 2 24 6 0 ppublish 25488089 10.1111/1471-0528.13155

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2015 BJOG : an international journal of obstetrics and gynaecology

47. A retrospective study to correlate breech presentation and enhanced risk of postspinal hypotension during cesarean delivery (PubMed)

A retrospective study to correlate breech presentation and enhanced risk of postspinal hypotension during cesarean delivery Subarachnoid blockade for cesarean section still poses a threat of profound hypotension and can result in unstable maternal and fetal hemodynamics. The correlation of fetal breech and vertex presentation with the occurrence of hypotension under spinal anesthesia is reviewed in this retrospective, double-blind study.The study was conducted on pregnant females scheduled (...) for a lower segment cesarean section between January 2014 and December 2014. After applying inclusion criteria, 568 patients were recruited in the study out of which 363 had vertex and 184 patients had breech presentation. They were divided into two groups, Group I and Group II. The monitoring and therapeutic data (blood pressure, heart rate, arterial oxygen saturation, and dose of vasopressor/atropine) recovered from automated data analysis were analyzed retrospectively for prevalence of hypotension

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2015 Local and regional anesthesia

48. Humerus Diaphysis Fracture in a Newborn during Vaginal Breech Delivery (PubMed)

Humerus Diaphysis Fracture in a Newborn during Vaginal Breech Delivery While most obstetricians are familiar with fracture of the clavicle in newborns during birth, an unlucky minority of obstetricians has encountered long-bone fractures in newborns as well. This complication is traumatic not only for the neonate, but also for the family and the obstetrician; it is also difficult to explain. Fortunately, the long-term prognosis for fracture of the long bones is excellent. Both vaginal (...) and cesarean breech deliveries and maneuvers can be responsible for birth traumas, including long-bone fractures. This case report presents a newborn with breech presentation delivered vaginally that resulted in humerus diaphysis fracture.

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2015 Case reports in obstetrics and gynecology

49. Preterm Breech Presentation: A Comparison of Intended Vaginal and Intended Cesarean Delivery. (PubMed)

Preterm Breech Presentation: A Comparison of Intended Vaginal and Intended Cesarean Delivery. To study the association of the intended mode of delivery and perinatal morbidity and mortality among breech fetuses who are delivered preterm.We conducted a nationwide cohort study of women with a singleton pregnancy in breech presentation who delivered preterm (26 0/7-36 6/7 weeks of gestation) in the years 2000-2011. We compared perinatal outcomes according to the intended and actual mode (...) of delivery using multivariate logistic regression analysis. We performed subgroup analyses of gestational age and parity.We studied 8,356 women with a preterm singleton breech delivery. Intended cesarean delivery (n=1,935) was not associated with a significant reduction in perinatal mortality compared with intended vaginal delivery (n=6,421) (1.3% compared with 1.5%; adjusted odds ratio [OR] 0.97, 95% confidence interval [CI] 0.60-1.57). However, the composite of perinatal mortality and morbidity

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2015 Obstetrics and Gynecology

50. Delivery of breech presentation at term gestation in Canada, 2003-2011. (PubMed)

Delivery of breech presentation at term gestation in Canada, 2003-2011. To examine neonatal mortality and morbidity rates by mode of delivery among women with breech presentation at term gestation.We carried out a population-based cohort study examining neonatal outcomes among term, nonanomalous singletons in breech presentation among all hospital deliveries in Canada (excluding Quebec) between 2003 and 2011. Mode of delivery was categorized into vaginal delivery, cesarean delivery in labor (...) , and cesarean delivery without labor. Composite neonatal mortality and morbidity (death, assisted ventilation, convulsions, or specific birth injury) was the primary outcome. Logistic regression was used to estimate the independent effects of mode of delivery.The study population included 52,671 breech deliveries; vaginal deliveries increased from 2.7% in 2003 to 3.9% in 2011, and cesarean deliveries in labor increased from 8.7% to 9.8%. Composite neonatal mortality and morbidity rates at 37 weeks

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2015 Obstetrics and Gynecology

51. Neonatal outcome of singleton term breech deliveries in Norway from 1991 to 2011. (PubMed)

Neonatal outcome of singleton term breech deliveries in Norway from 1991 to 2011. The objective of this study was to examine the association between planned mode of delivery and neonatal outcomes in breech deliveries.In this retrospective cohort study we studied singleton term breech deliveries in Norway from 1991 to 2011 (n = 30 861) using the Medical Birth Registry of Norway. We compared planned vaginal delivery with planned cesarean delivery across two time periods: from 1 January 1991 to 31 (...) 34.4 to 51.3% over the period. Simultaneously, early neonatal mortality rate (0-6 days) declined (from 0.10% to 0.04%, p = 0.04). During the second period, 30.7% of term breech presentations were delivered vaginally. Eight deaths in the planned vaginal vs. four in the planned cesarean groups were observed (OR 2.11 95% CI 0.64-7.01). Neonatal morbidity outcomes were significantly worse in planned vaginal deliveries compared with planned cesarean deliveries in both periods.Overall intrapartum

2015 Acta Obstetricia et Gynecologica Scandinavica

52. Pregnancy outcomes in breech presentation analyzed according to intended mode of delivery. (PubMed)

Pregnancy outcomes in breech presentation analyzed according to intended mode of delivery. Optimal mode of delivery in breech presentation has been widely examined and debated. The aim of this study was to compare perinatal and maternal outcomes with either a policy of planned vaginal delivery or planned cesarean section in breech presentation.This was a registry-based retrospective cohort study from Turku University Hospital, Finland with 1418 singleton breech deliveries at term over a period (...) of 11 years (January 2002 to December 2012). Data were collected from the mothers' medical records.Apgar scores at 5 min as well as umbilical artery pH values were significantly lower in the planned vaginal breech delivery group compared with the planned cesarean section group, suggesting a short-lasting delayed recovery after birth. There were more puerperal infections in planned cesarean section group compared with the planned vaginal delivery group.The results confirm that planned vaginal breech

2015 Acta Obstetricia et Gynecologica Scandinavica

53. Risks of vaginal breech delivery at term compared to elective caesarean section - Reply on comment by Page. (PubMed)

Risks of vaginal breech delivery at term compared to elective caesarean section - Reply on comment by Page. 25676439 2015 04 29 2018 12 02 1600-0412 94 4 2015 Apr Acta obstetricia et gynecologica Scandinavica Acta Obstet Gynecol Scand Risks of vaginal breech delivery at term compared to elective cesarean section--reply to comment by Page. 442 10.1111/aogs.12603 Vlemmix Floortje F Department of Obstetrics and Gynecology, Academic Medical Center, University of Amsterdam, Amsterdam (...) , the Netherlands. Mol Ben Willem BW Kok Marjolein M all co-authors eng Letter Comment 2015 03 01 United States Acta Obstet Gynecol Scand 0370343 0001-6349 IM Acta Obstet Gynecol Scand. 2015 Apr;94(4):441 25311000 Acta Obstet Gynecol Scand. 2014 Sep;93(9):888-96 25113411 Breech Presentation Cesarean Section statistics & numerical data Female Humans Pregnancy 2015 2 14 6 0 2015 2 14 6 0 2015 4 30 6 0 ppublish 25676439 10.1111/aogs.12603

2015 Acta Obstetricia et Gynecologica Scandinavica

54. Prehospital Breech Delivery with Fetal Head Entrapment -A Case Report and Review. (PubMed)

Prehospital Breech Delivery with Fetal Head Entrapment -A Case Report and Review. We present a case in which an emergency medical services (EMS) crew was called for a precipitous breech delivery with fetal head entrapment that was unrelieved following standard prehospital interventions and eventually resulted in neonatal cardiac arrest and death. Although this is a rare occurrence, EMS responders must have adequate training and guidelines on how to assist with vaginal delivery of breech

2015 Prehospital emergency care

55. What is the safest mode of birth for extremely preterm breech singleton infants who are actively resuscitated? A systematic review and meta-analyses. (PubMed)

What is the safest mode of birth for extremely preterm breech singleton infants who are actively resuscitated? A systematic review and meta-analyses. The safest delivery mode of extremely preterm breech singletons is unknown.To determine safest delivery mode of actively resuscitated extremely preterm breech singletons.We searched Cochrane CENTRAL, MEDLINE, EMBASE, CINAHL and ClinicalTrials.gov from January 1994 to May 2017.We included studies comparing outcomes by delivery mode in actively (...) resuscitated breech infants between 23+0 and 27+6 weeks.We synthesised data using random effects, generated odds ratios, 95% confidence intervals and number-needed-to-treat (NNT). Our primary outcomes were death (neonatal, before discharge, or by 6 months) and severe intraventricular haemorrhage (grades III/IV), stratified by gestational age (23+0 -24+6 , 25+0 -26+6 , 27+0 -27+6 weeks).We included 15 studies with 12 335 infants. We found that caesarean section was associated with a 41% decrease in odds

2017 BJOG : an international journal of obstetrics and gynaecology

56. Uptake of external cephalic version for term breech presentation: an Australian population study, 2002-2012. (PubMed)

Uptake of external cephalic version for term breech presentation: an Australian population study, 2002-2012. The safety, efficacy, and cost-effectiveness of external cephalic version (ECV) for term breech presentation has been demonstrated. Clinical guidelines recommend ECV for all eligible women, but the uptake of this procedure in the Australian healthcare setting is unknown. This study aimed to describe ECV uptake in New South Wales, the most populous state of Australia, during 2002 to 2012 (...) .Data from routine hospital and birth records were used to identify ECVs conducted at ≥36 weeks' gestation. Women with ECV were compared to women who were potentially eligible for but did not have ECV. Eligibility for ECV was based on clinical guidelines. For those with ECV, birth outcomes following successful and unsuccessful procedures were examined.In N = 32,321 singleton breech pregnancies, 10.5% had ECV, 22.3% were ineligible, and 67.2% were potentially eligible but did not undergo ECV

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2017 BMC Pregnancy and Childbirth

57. Amnioinfusion for women with a singleton breech presentation and a previous failed external cephalic version: a randomized controlled trial. (PubMed)

Amnioinfusion for women with a singleton breech presentation and a previous failed external cephalic version: a randomized controlled trial. Our trial aimed to assess the effectiveness of amnioinfusion for a second attempt at external cephalic version (ECV).This open randomized controlled trial was planned with a sequential design. Women at a term ≥36 weeks of gestation with a singleton fetus in breech presentation and a first unsuccessful ECV were recruited in two level-3 maternity units (...) . They were randomly allocated to transabdominal amnioinfusion with a 500-mL saline solution under ultrasound surveillance or no amnioinfusion before the second ECV attempt. Trained senior obstetricians performed all procedures. The primary outcome was the cephalic presentation rate at delivery. Analyses were conducted according to intention to treat (NCT00465712).Recruitment difficulties led to stopping the trial after a 57-month period, 119 women were randomized: 59 allocated to amnioinfusion + ECV

2017 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

58. Risk factors associated with adverse perinatal outcome in planned vaginal breech labors at term: a retrospective population-based case-control study. (PubMed)

Risk factors associated with adverse perinatal outcome in planned vaginal breech labors at term: a retrospective population-based case-control study. Vaginal breech delivery is associated with adverse perinatal outcome. The aim of this study was to identify factors associated with adverse perinatal outcome in term breech pregnancies, and to provide clinicians an aid in selecting women for a trial of vaginal labor with the fetus in breech position.We conducted a retrospective, nationwide (...) , Finnish population-based case-control study. All planned singleton vaginal deliveries at term with the fetus in breech position between the years 2005 and 2014 were analyzed. The study's end point was a composite set of adverse perinatal outcomes. All infants with an adverse outcome were compared to the infants with normal outcomes. A multivariate logistic regression model was used to analyze the data.An adverse perinatal outcome was recorded for 73 (1.5%) infants. According to the study results fetal

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2017 BMC Pregnancy and Childbirth

59. Maternal experiences of vaginal breech delivery. (PubMed)

Maternal experiences of vaginal breech delivery. The optimal mode of breech birth remains controversial. In Finland, a trial of vaginal delivery is possible if strict selection criteria are met. As clinical practice in managing vaginal breech birth differs from that in normal delivery, the birth experience may also be different. This cohort study compares the childbirth experience between term breech and vertex deliveries.Intended vaginal term breech births from 2008 to October 2012 were (...) included, and for every breech delivery, a vertex control was selected. The proportions of deliveries ending in a cesarean section and of mothers who had given birth vaginally before were equal in both groups. Three hundred eight mothers were sent the childbirth experience questionnaire and 170 returned it.The birth experience does not differ between breech and vertex births, except for aspects with respect to the choice of birthing position. Indications of an even more positive experience were

2014 Birth

60. Term breech deliveries in the Netherlands: did the increased cesarean rate affect neonatal outcome? A population-based cohort study. (PubMed)

Term breech deliveries in the Netherlands: did the increased cesarean rate affect neonatal outcome? A population-based cohort study. The aim of this study was to evaluate the effect of the increased cesarean rate for term breech presentation on neonatal outcome. We also investigated whether the clinical case selection for vaginal delivery applied by Dutch obstetricians led to an optimization of neonatal outcome, or whether there is still room for improvement in terms of perinatal (...) outcome.Retrospective cohort.The Netherlands.Singleton term breech deliveries from 37+0 to 41+6 weeks, excluding fetuses with congenital malformations or antenatal death.We used data from the Dutch national perinatal registry from 1999 up to 2007.Perinatal mortality and morbidity.We studied 58,320 women with a term breech delivery. There was an increase in the elective cesarean rate (from 24 to 60%). As a consequence, overall perinatal mortality decreased [1.3 0/00 vs. 0.7 0/00;odds ratio 0.51 (95% confidence

2014 Acta Obstetricia et Gynecologica Scandinavica

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