BackgroundMost countries recommend planned cesarean section in breech deliveries, which is considered safer than vaginal delivery. As one of few countries in the western world Norway has continued to practice planned vaginal delivery in selected women. The aim of this study is to evaluate prospectively registered neonatal and maternal outcomes in term singleton breech deliveries in a Norwegian hospital during a ten years period. We aim to compare maternal and neonatal outcomes in term breech pregnancies subjected either to planned vaginal or elective cesarean section.MethodsA prospective registration study including 568 women with term breech deliveries (>37 weeks) consecutively registered at Sorlandet Hospital Kristiansand between 2001 and 2011. Fetal and maternal outcomes were compared according to delivery method; planned vaginal delivery versus planned cesarean section.ResultsOf 568 women, elective cesarean section was planned in 279 (49%) cases and vaginal delivery was planned in 289 (51%) cases. Acute cesarean section was performed in 104 of the planned vaginal deliveries (36.3%). There were no neonatal deaths. Two cases of serious neonatal morbidity were reported in the planned vaginal group. One infant had seizures, brachial plexus injury, and cephalhematoma. The other infant had 5-minutes Apgar < 4. Twenty-nine in the planned vaginal group (10.0%) and eight in the planned cesarean section group (2.9%) (p < 0.001) were transferred to the neonatal intensive care unit. However, only one infant was admitted for ≥4 days. According to follow-up data (median six years) none of these infants had long-term sequelae. Regarding maternal morbidity, blood loss was the only variable that was significantly higher in the planned cesarean section group versus in the vaginal delivery group (p < 0.001).ConclusionsStrict guidelines were followed in all cases. There were no neonatal deaths. Two infants had serious neonatal morbidity in the planned vaginal group without long-term sequelae.

The health authorities of Stockholm county recently published a Health Technology Assessment report: "Fetal monitoring with computerized STAN analysis during labor - a systematic review" with the aim to ensure that high quality research information on costs, effectiveness and broader impact of health technologies is analysed and presented in the most efficient way for those who use, manage and work in this field. The report claims to analyse available research in relation to ST interval analysis of fetal electrocardiogram (STAN) and concludes that scientific evidence for advantages of the STAN technology for maternal and fetal outcome was insufficient and that clinical use cannot be recommended and should be restricted to research protocols. The Norwegian reference group for fetal surveillance points out that the report suffers from two insufficiencies: selection bias by not providing a complete collection of the evidence for the clinical performance of the STAN technology and, secondly, that it does not provide evidence-based alternative methods.

Topics: Systems-based Practice, Obstetric Complications E xternal cephalic version (ECV) is used by obstetricians and midwives to reduce the risks associated with vaginal breech birth. ECV is generally performed around 36 to 37 weeks' gestation. Maternal pain is one of the 2 most common reasons to abort an attempted ECV. Several studies have concluded that regional anesthesia increases the success rate of ECV. The authors posed several questions that challenge the assumptions and conclusions of those studies:How much gain would occur in reducing the cesarean delivery rate and does this balance with the resources needed for anesthesia-facilitated ECV? Research has currently not shown a significant reduction in the rate of cesarean deliveries by increasing the rate of ECVs.What is the incidence of postprocedure complications that may not be recognized until the onset of labor, and does anesthesia-facilitated ECV balance maternal choice with fetal/neonatal safety? If the mother is under anesthesia, are obstetricians more likely to use excessive force and lead to a rise in the procedural complication? Several studies have found ECV to overall be a safe procedure. No increases in the rates of major complications have been identified. The risk of some minor complications increased with anesthesia-facilitated ECV. The authors suggest offering these services to a select subgroup of women who have a failed initial attempt at ECV.What percentage of women who had a successful ECV ends up with an intrapartum cesarean delivery in any case? One study published in 1997 found that despite a high ECV success rate and a low reversion rate, the incidence of cesarean delivery was not reduced. However, even though successful ECV significantly reduced the need for elective cesarean delivery, more than twice as many women in the ECV cohort still required intrapartum cesarean delivery when compared with the control cohort.Overall, it has been found that neuraxial anesthesia increases ECV success and may reduce the overall rate of cesarean delivery. Future studies are required to evaluate delivery outcomes and complications. Future research should also demonstrate that the maternal/fetal/neonatal risk to benefit ratio and overall resource allocation favors ECV.

Vi har med stor sorg mo a budskapet om at Torunn Eikeland (f. 1953) er død. Hun var en av Norges fremste fødselsleger -vi har mistet en av de beste vi hadde. Torunn ble bare 61 år.