Delivery of the fetus in breech presentation
- G Justus Hofmeyr, MD
G Justus Hofmeyr, MD
- University of the Witwatersrand
- University of Fort Hare, South Africa
Vaginal breech delivery in selected cases, as described below, is associated with a low risk of complications and is considered a reasonable option for delivery by some clinicians and pregnant women. Even in institutions with a policy of routine cesarean delivery for breech presentation, vaginal breech deliveries occur because of situations such as precipitous delivery, out of hospital delivery, lethal fetal anomaly or fetal death, and mother's preference for vaginal birth. Therefore, it is essential for clinicians to maintain the skills of vaginal breech delivery.
This topic will review techniques for breech birth. Choosing the best route of delivery of the fetus in breech presentation is reviewed separately. (See "Overview of issues related to breech presentation".)
VAGINAL BREECH DELIVERY
Criteria for an optimal patient selection — Various criteria have been developed to minimize the risk of vaginal breech delivery. These criteria for patient selection are largely based upon clinical experience, and typically include the following characteristics [1-4]. In a prospective series of over 8000 women with breech presentation at term, only about 30 percent of women met these criteria .
●No contraindication to vaginal birth (eg, placenta previa, contracted pelvis, cord presentation) – There is no convincing evidence that information from pelvimetry (clinical, radiograph, magnetic resonance imaging, computed tomography) for managing women with breech presentation leads to improved neonatal outcome . However, there are few data from large or randomized trials.
●No prior cesarean deliveries.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- VAGINAL BREECH DELIVERY
- Criteria for an optimal patient selection
- Labor management
- Delivery of the term fetus
- - Graphic aids
- - Maternal preparation
- - General principles
- - Trunk and legs
- - Arms
- - Head
- - Use of forceps
- - Head entrapment
- Delivery of the preterm fetus
- - Dührssen incisions
- CESAREAN BREECH DELIVERY
- Mature breech
- Premature breech
- SPECIAL SITUATIONS
- Delivery of the hydrocephalic fetus in breech presentation
- Delivery in the absence of skilled assistance and appropriate facilities
- NEWBORN EVALUATION
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS
- Vaginal delivery
- Cesarean delivery