Changes in vaginal breech delivery rates in a single large metropolitan area

Hehir, Mark P.; O’Connor, Heather; Kent, Etaoin; Fitzpatrick, Chris; Boylan, Peter; Coulter-Smith, S; Geary, Michael; Malone, Fergal D.

doi:10.1016/j.ajog.2012.03.029

Cited by 35 publications

(20 citation statements)

References 17 publications

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“…Today approximately 20% of breeches are delivered vaginally in the Netherlands compared to 50% before the TBT [7]. The numbers are even lower in Scotland, Ireland and Denmark; 5 – 10% today versus 20 – 23% before the TBT [10,19,20]. …”

Section: Discussionmentioning

confidence: 99%

Vaginal breech delivery: results of a prospective registration study

Vistad

Cvancarova

Hustad

et al. 2013

BMC Pregnancy Childbirth

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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.

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Section: Discussionmentioning

confidence: 99%

Vaginal breech delivery: results of a prospective registration study

Vistad

Cvancarova

Hustad

et al. 2013

BMC Pregnancy Childbirth

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“…The term breech trial was widely credited as the death knell for vaginal breech delivery, with its findings being adopted with an exceptional level of acceptance within the obstetric community and hence caesarean delivery has become the standard method of delivery for breech presenting infants. Published data, however, have suggested that a decrease in vaginal breech delivery was widespread prior to publication of the trial and that its arrival served to simply cement clinician's opinions regarding delivery route for breeches 6. The pattern of the decline in vaginal breech delivery in the years prior to publication of the term breech trial can be seen in figure 1.…”

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confidence: 99%

Trends in vaginal breech delivery

Hehir

2015

J Epidemiol Community Health

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“…Cette augmentation du taux de césarienne existe également dans d'autres pays tels que les Pays-Bas [5][6][7], les pays scandinaves [8,9] et avait débuté au Canada il y a près de 30 ans [10]. Aux États-Unis, une récente étude annonce un chiffre de près de 90 % toutes parités confondues [11]. L'augmentation en 16 années (de 1993 à 2008) a fait passé le taux de 76,9 % (déjà près de 20 % de plus que nos pratiques françaises en 1993) à 89,7 % qu'il sera difficile d'améliorer si on laisse aller les sièges à terme.…”

Section: Discussionunclassified

“…À de tels taux, il devient difficile d'analyser les résultats des groupes « voie basse », puisque qu'ils ne sont plus que des accidents de programmation et que, de plus, la perte d'expertise à toute pratique manoeuvrière est un fait avéré depuis longtemps aux États-Unis datant de bien avant le Term Breech Trial [12]. L'amélioration de la mortalité néonatale au court des quatre dernières années de l'étude ne peuvent selon les aveux même des auteurs être attribués en totalité à la césa-rienne quasi-systématique [11].…”

Section: Discussionunclassified