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Mode of Delivery for Breech Presentation
Here are some studies that discuss management of the breech presentation and the mode of delivery.
- Jaffa AJ et al: Management of term breech presentation in primigravidae. Br J
Obstet Gynaecol 1981;88:721-4.
- Rosen M and Chik L: The effect of delivery route on outcome in breech
presentation. Am J Obstet Gynecol 148:909, 1984. No improvement in neonatal
mortality or morbidity shown with increase in cesarean section.
- Rosen MG, Chik L: The association between cesarean birth and outcome in
vertex presentation. Am J Obstet Gynecol 1984;150:775.
- Green JE et al. Has an increased cesarean section rate for term breech
delivery reduced the incidence of birth asphyxia, trauma and death? Am J
Obstet Gynecol 1982;142:643.
- Oian P et al: Breech delivery: an obstetrical analysis. Acta Obstet Gynecol
Scand 67:75-79, 1988. (Large rise in breech c-sec rate in Norway in late 70s
at this hospital, "Neonatal mortality figures were not significantly improved
for infants delivered by cesarean section.")
- Weiner CP: Vaginal breech delivery in the 1990s. Clinical Obstet and Gynecol
35:3,559-69, 1992. ["Since then (1959), others have observed that the
dramatic increase in the rate of cesarean delivery for the breech
presentation has not been associated with a parallel improvement in outcome
above that observed for the vertex fetus during the same time."]
["Third, when good clinical sense was applied, the selected near-term and
term breech fetus was delivered as safely through the vagina as through the
abdomen. Fourth, cesarean section did not eliminate the risk of a traumatic
delivery. The latter is contrary to the beliefs of many medical, legal, and
lay individuals."]
- Woo JSK et al: Term breech delivery - is a high cesarean section rate
justified? ["No significant difference in perinatal outcome was noted in the
group delivered vaginally in two years."] Aust. NZ J Obstet Gynaec 23:25-27,
1983.
- Bird, CC and McElin, TW: A 6-year prospective study of term breech deliveries
utilizing the Zatuchni-Andros Prognostic Scoring Index. Am J Obstet Gynecol
121:551,1975.
- Collea JV et al: The randomized management of term frank breech presentation:
Vaginal delivery vs. cesarean section, Am J Obstet Gynecol 131:186,1978.
- Collea JV: Current management of breech presentation, Clin Obstet Gynecol.
23:525, 1980. ("It should be understood, however, that infants with breech
presentation who are deliverd incorrectly may be injured at cesarean section.
Every obstetrician should be thoroughly familiar with the manual art of
breech extraction before attempting to perform an abdominal breech delivery,
for the manual techniques of breech delivery from the uterus at cesarean
section involve the same dexterity that is essential for a safe vaginal
delivery.")
- Collea JV et al. The randomized management of term frnk breech presentation:
a study of 208 cases. Am J Obstet Gynecol 1980;137:235-44. (Bruce Rolf, MD,
writes: "Not all infants are easily delivered by cesarean section, especially
those with breech presentation. Many times we have seen unnecessary delays
and perhaps traumatized infants when an inadequate transverse lower-segment
incision was used.")
- Gimovsky ML et al: Neonatal performance of the selected term vaginal breech
delivery, Obstet Gynecol 56:687, 1980.
- Gimovsky ML et al: Randomized management of the nonfrank breech presentation
at term: a preliminary report. Am J Obstet Gynecol 1983;146-34-40.
- Myers SA and Gleicher N: Breech delivery: Why the dilemma? Am J Obstet
Gynecol 1987;156-6-10
- Bilodeau R and Marier R: Breech presentation at term, Am J Obstet Gynecol
130:555, 1978.
- Rovinsky JJ et al: Management of breech presentation at term, Am J
Obstet Gynecol 115:497, 1973. ("routine elective cesarean section for term
breech presentation is not justified.")
- Mann LI and Gallant JM: Modern management of the breech delivery, Am J Obstet
Gynecol 134:611, 1979. (457 breech deliveries - no "significant improvement
in neonatal mortality and morbidity rates for those delivered by cesarean
section vs. vaginal delivery").
- Croughan-Minihane MS et al: Morbidity among breech infants according to
method of delivery, Obstet Gynecol 75:821, 1990. (1240 singleton breeches
- Graves W: Breech delivery in 20 years of practice, Am J Obstet Gynecol
137:229,1980. - JP Shively, MD, writes: "It was once said that to judge an
obstetrician, one should observe his management of a breech presentation.
Perhaps this adage is becoming passe, so I wonder how the next generation of
obstetricians will perform when they have an emergency situation requiring
delivery. I understand that many residents in training are not being taught
how to deliver breech babies." JO McCall, MD, writes: "I submit to you that
you will see some very awkward and difficult breech deliveries at the time of
cesarean section. I encourage all of you who are preceptors with resident
training programs to urge every resident to read Potter's classic description
of how to handle a breech."
- Green J et al. Has an increased cesarean section rate for term breech
delivery reduced the incidence of birth asphyxia, trauma, and death? Am J
Obstet Gynecol 142:643, 1982.
770 term breech deliveries, Ontario. "The results of this study show that an
increase in the rate of cesarean section for term breech deliveries from 22%
to 94% has not reduced unfavorable outcome significantly, although a trend
toward decreased trauma and death may exist."
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