Lumbar Epidural Block and the Breech Presentation

BOWEN-SlMPKINS, P.; Fergusson, I. L. C.

doi:10.1093/bja/46.6.420

Cited by 15 publications

(7 citation statements)

References 9 publications

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“…In this study, despite the liberal use of oxytocin augmentation and willingness of the obstetricians to wait for the breech to descend before encouraging expulsive efforts, evident from the duration of the second stage, the incidence of caesarean section was higher among women who had an epidural block compared with those who did not. This observation contrasts with some previous reports (Bowen–Simpkins & Ferguson 1974; Crawford & Weaver 1982; Rudick et al 1983) which found no increase in caesarean deliveries in women of mixed parity. Indeed, one report (Darby et al 1976) commented on a 50% reduction in emergency caesarean sections among women, also of mixed parity, who had epidural analgesia.…”

Section: Discussioncontrasting

confidence: 98%

Breech delivery and epidural analgesia

Chadha

Mahmood

Dick

et al. 1992

BJOG

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Objective To examine the effect of epidural analgesia on the progress and outcome of spontaneous labour in women with a singleton breech presentation at term (3=37 weeks). Design A retrospective study. Setting Data Bank, Aberdeen Maternity Hospital. Subjects 643 women (273 primiparae and 370 multiparae) with a singleton breech presentation and spontaneous onset of labour at term. Outcome measures Duration of labour; augmentation of labour with oxytocin infusion; caesarean section rates. Results Epidural analgesia was associated with a significantly increased need for augmentation of labour with oxytocin infusion (P<0.001) and longer duration of labour (P<0.001), irrespective of parity. Comparing women who had epidural analgesia with those who did not, there was no significant difference in caesarean section rates in the first stage of labour in primiparae (odds ratio 1.79; 95% CI0.88–3.63) or multiparae (odds ratio 0.97; 95% CI 0.48–1.96). Epidural analgesia was associated with a significantly increased likelihood of caesarean section in the second stage of labour, both in primiparae (odds ratio 5.43; 95% CI 2.46–11.95) and multiparae (odds ratio 5.37; 95% CI 2.07–13.87). The increased likelihood of caesarean section in the second stage in primiparae with epidurals was independent of the extent of cervical dilatation (<3 cm or ≥3 cm) on admission. However, in multiparae with epidurals, the difference in second stage caesarean section rate was significant only when initial cervical dilatation was <3 cm (odds ratio 3.65; 95% CI 1.14–11.65). Conclusion Epidural analgesia was associated with longer duration of labour, increased need for augmentation of labour with oxytocin infusion and a significantly higher caesarean section rate in the second stage of labour.

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Section: Discussioncontrasting

confidence: 98%

Breech delivery and epidural analgesia

Chadha

Mahmood

Dick

et al. 1992

BJOG

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“…Breech delivery should be preceded by a detailed anomaly scan as a severe or lethal defect may affect the subsequent management. Our findings confirm those of others which have shown that the second stage is prolonged in patients who receive epidural analgesia [6,11,13]. Of course, this is a potentially biased finding as patients with poor progress are more likely to require epidural analgesia.…”

Section: Discussionsupporting

confidence: 90%

Balancing the risks of planned cesarean section and trial of vaginal delivery for the mature, selected, singleton breech presentation

Songane¹,

Thobani²,

Malik³

et al. 1987

Journal of Perinatal Medicine

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“…Our rate for failed trial of vaginal delivery was high, 59 out of 149 (40%), and represents a marked increase over the rate of 6% (81133) for a series from the same hospital covering the years 1971and 1972(Bowen-Simpkins & Fergusson 1974. The reasons for failed trial in the present series are analysed in Tablc 6 where it can be seen that poor progress, despite frequent use of oxytocin, is the commonest indication for a non-elective caesarean section.…”

Section: Discussionmentioning

confidence: 56%

“…We were able to compare some of our results with a published series from the same hapita1 covering the years 1971-1972(Bowen-Simpkins & Fergusson 1974.…”

Section: Methodsmentioning

confidence: 95%

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Management of the mature selected breech presentation: an analysis based on the intended method of delivery

Bingham¹,

Hird²,

Lilford

1987

BJOG

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Summary. The outcome of 313 mature singleton breech deliveries, covering a 3‐year period at the Queen Charlotte's Hospital, is reviewed. Maternal and fetal outcome were analysed by the intention to deliver vaginally compared with planned caesarean section. There was no serious fetal morbidity or mortality in either of these groups despite considerable mechanical difficulty with vaginal delivery of the head in one patient. One woman in this group required hysterectomy for haemorrhage after an emergency caesarean section. Planned caesarean sections were carried out in 125 cases (40%). Trial of vaginal delivery was abandoned in 59 (40%) of the 149 women where this was attempted. Epidural analgesia appears to increase the duration of the second stage of labour in those who were delivered vaginally. Younger women and those with smaller babies were more likely to succeed with a trial of vaginal delivery but there was no relation between birthweight and the radiological obstetric conjugate and success or failure of trial of labour.

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Lumbar Epidural Block and the Breech Presentation

Cited by 15 publications

References 9 publications

Breech delivery and epidural analgesia

Breech delivery and epidural analgesia

Balancing the risks of planned cesarean section and trial of vaginal delivery for the mature, selected, singleton breech presentation

Management of the mature selected breech presentation: an analysis based on the intended method of delivery

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