Breech Deliveries

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Birth outcomes of singleton term breech deliveries in Jimma University Medical Center, Southwest Ethiopia

Birth outcomes of singleton term breech deliveries in Jimma University Medical Center, Southwest Ethiopia

Results: The incidence of singleton term breech delivery was 5.3%. Majority, (52.8%) of them had undergone emer- gency cesarean delivery (C/D), and 38.9% had vaginal breech delivery. There were 14 (13.9%) intrapartum fetal deaths of whom 5.6% were recorded at JUMC. A quarter (25%) of the neonates required admission to the neonatal intensive care unit; 40.7% had perinatal asphyxia, and there were 3 early onset neonatal deaths making up a perinatal mortality rate of 157.4 per 1000 breech births. The incidence of breech delivery was relatively high. Vaginal breech delivery was lower. Significant proportions of adverse perinatal outcomes were recorded. Introduction of a protocol for managing breech deliveries to select eligible women for trial of breech delivery and strengthen training of junior health profes- sionals regularly on how to conduct assisted vaginal breech delivery to improve perinatal outcome is recommended. Further studies to identify determinants of perinatal outcomes is recommended.

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AN AUDIT OF SINGLETON BREECH DELIVERIES IN A HOSPITAL WITH A HIGH RATE OF VAGINAL DELIVERY

AN AUDIT OF SINGLETON BREECH DELIVERIES IN A HOSPITAL WITH A HIGH RATE OF VAGINAL DELIVERY

The term breech trial (TBT) has brought about radical changes but it is debatable whether it provides unequivocal evidence regarding the practice of breech deliveries. There is a need to publish the data of a study that was performed before the era of the TBT in a hospital where there was a high rate of breech vaginal delivery. The objectives were to ascertain the incidence, mode of delivery and fetal outcome in singleton breech deliveries. The study design was a retrospective cohort study where 165 consecutive breech and 165 controls (cephalic) were included. Statistical analysis, used were Chi squared and Fischer’s exact test. P<0.05 is taken as the level of significance. The incidence of breech deliveries was found to be 3% and has remained fairly constant but the rate of breech vaginal delivery has fallen and the CS rates have increased. Even though more breech compared to controls were significantly sectioned, majority of the breeches {n=137 (83%)} were planned for vaginal delivery and in these patients two-thirds attained vaginal delivery. There was 1 fetal death in the CS group compared to 12 deaths in the vaginally delivered breech. However, most death in the breech delivered vaginally are unavoidable. In conclusion, there is a high rate of breech vaginal delivery in this series of patients and most perinatal deaths were not related to the mode of delivery.

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Vaginal breech delivery: results of a prospective registration study

Vaginal breech delivery: results of a prospective registration study

Most studies of term breech deliveries are retrospect- ive and based on registry data, which make comparisons difficult because of lack of antenatal and postnatal infor- mation. Our study is in terms of design comparable to a large prospective observation study from France/Belgium that included 8105 women [17], According to that study, vaginal delivery of breech infants remains standard prac- tice in France. The proportion of planned vaginal deliver- ies was 51% in 1998 and decreased to 31% in the study period (2001–2002). In our study, vaginal delivery was planned in 51% of breech births throughout the study period (varying from 45% in 2003 to 57% in 2010). In the study by Goffinet et al. [17], 54 (2%) in the planned vaginal group were transferred to the NICU, versus (29) 10% in our study. However, in our study only one of 29 infants was admitted at the NICU for more than 4 days, com- pared to 23/54 (43%) of the infants in the French/Belgian study. The main reason is probably variations in routines, including a low threshold for transfer to the NICU at our hospital, reflected by the short admission time. Cul- tural and traditional differences between the countries may also explain variations in management of delivery. In the French/Belgium study, duration of labor (first stage) was ≥ 7 hours in 1.4% versus 36.3% in our study. Norwegian doctors and women seem to accept longer duration of labor before cesarean section is decided. In our study active pushing started after the presenting part had reached the outlet in 93.5%, in accordance with the Goffinet study (96.4%). Furthermore, the percentage of women with active phase of the second stage of labor (i.e. pushing) longer than 60 minutes was only 2/185 (1.1%), in line with the French/Belgian study (0.2%). According to the Norwegian guidelines, active pushing should be awaited until the presenting part reaches the outlet and is thus followed in a majority of the deliver- ies. In contrast, active phase of second stage of labor longer than 60 minutes was 5.0% in TBT possibly due to earlier start of pushing than in our study. Shorter duration of active pushing is known to increase the chances of a vaginal birth [18].

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Breech delivery at a University Hospital in Tanzania

Breech delivery at a University Hospital in Tanzania

The almost threefold increase in CD rate for breech presentation was not associated with an overall im- provement in breech births or improved survival for breech-delivered infants. This is contrary to the TBT study and other studies in Western settings [1, 8, 19, 20]. One explanation, at least a partial explanation, for this difference might be selection bias, as there was a gradual improvement in maternity care in Dar-es- Salaam as the surrounding district hospitals improved [17]. Muhimbili National Hospital had a 40 % decrease in deliveries between 2000 and 2002 and between 2009 and 2011, which was concomitant to an increase in re- ferral cases, from 7 to 28 % [16]. The higher proportion of referred patients also includes patients with breech presentation in labor, and they had worse outcome, ir- respective of mode of delivery. Another reason for this difference could have been reduced staff skills in assisted breech delivery, as, in our sample, the number of vaginal breech deliveries decreased from three per week to one every 2 weeks [3]. Van Roosmalen and Meguid highlight that settings that increasingly use CD may not have trained staff with the skills to assist vagi- nal breech delivery, and that this staff will need skills training in this area [3]. Hannah et al. found that planned CD for breech presentation did not reduce ser- ious morbidity in newborns in high-PMR countries as much as in low-PMR countries. They recognized the possibility of the caregivers being more experienced in Table 3 Risk of moderate asphyxia (defined as 5-min Apgar

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A Outcome of breech delivery: caesarean section versus vaginal delivery at Patan Academy of Health Sciences, Patan

A Outcome of breech delivery: caesarean section versus vaginal delivery at Patan Academy of Health Sciences, Patan

Results: There were 896 breech deliveries out of a total 44,842 deliveries giving an incidence of 1.99%. One hundred thirteen (12.61%) of breech deliveries were through vaginal route while 431 (48.10%) and 352 (39.28%) were through emergency and elective caesarean sections respectively. There were 154(17.18% preterm intrauterine death. Among term pregnancy, there were 3-neonate deaths not associated with mode of delivery. There were 154(17.18%) preterm breech deliveries including 27(17.5%) preterm intrauterine death. Among term pregnancy, there were 3 neonatal deaths not associated with mode of delivery. None of the term infant had neurological morbidity comprising neonatal seizures, brachial plexus injury, chephalohematoma. Maternal blood loss was significantly higher is caesarean section group.

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Principles of physiological breech birth practice: a Delphi study

Principles of physiological breech birth practice: a Delphi study

Secter MB, Simpson AN, Gurau D, Snelgrove JW, Hodges R, Mocarski E, Pittini R, Windrim R, Higgins M, 2015. Learning From Experience: Qualitative Analysis to Develop a Cognitive Task List for Vaginal Breech Deliveries. Journal of Obstetetrics and Gynaecology Canada 37, 966–974.

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Study of mode of delivery in breech presentations

Study of mode of delivery in breech presentations

Child : There is no doubt that, as far as delivery is concerned, vertex presentation is the safest for the baby. The fetal mortality in breech delivery shows wide variations – from two percent to 30 percent. The is mainly due to the fact that in quite a number of cases, there are complicating factors which by themselves increase or add to the fetal risk. Hence it is necessary, when assessing the inherent risk to the fetus in breech deliveries, to discard the accentuating factors and then assess the risk.

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Cardiotocography in breech versus vertex delivery: an examiner blinded, cross sectional nested case control study

Cardiotocography in breech versus vertex delivery: an examiner blinded, cross sectional nested case control study

Oxytocin use has been associated with adverse peri- natal outcome in breech deliveries [32], and some insti- tutions disfavor the use of oxytocin augmentation in breech deliveries, considering failure to progress in labor an indication for cesarean delivery [13]. In this study, neither oxytocin augmentation nor uterine tachysystole was associated with adverse neonatal outcome, which may be due to a low threshold to intervene with patho- logical CTG traces that in turn were associated with uterine tachysystole. However, vertex fetuses may have been, in some cases, quickly delivered by vacuum ex- traction when signs of fetal distress are observed in the second stage of labor, unlike breech fetuses, which were delivered by slower CS in similar circumstances. After the decision to deliver by an emergency CS is made, oxytocin infusion is discontinued and, in selected cases, tocolysis is administered, which may result in intrauter- ine recovery of the fetus from short-term asphyxia. This may cause the actual effect of oxytocin and uterine tachysystole on neonatal depression to be underesti- mated, especially in the breech group.

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Undiagnosed Breech: towards a woman-centred approach

Undiagnosed Breech: towards a woman-centred approach

Nwosu et al’s 1993 study of 301 breech deliveries (101 elective caesarean sections, 122 planned VBB, 78 diagnosed in labour) at a large hospital in Liverpool found no difference in short term morbidity. The only statistical difference they did find between the groups was an increased rate of vaginal delivery among those diagnosed for the first time in labour. These findings found agreement with similar data from Bradford, presented in a follow-up letter, concerning 165 breech presentations in one year (Jackson and Tuffnell 1994). About one third were undiagnosed until labour, and of these 55% delivered vaginally compared with only 15% of those diagnosed antenatally.

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Caesarean deliveries in China

Caesarean deliveries in China

Definition of other terms utilized in the study based on Chinese terms: operative vaginal delivery includes forceps delivery, vacuum extraction delivery and breech extraction. Preterm birth was defined as delivery be- tween 24 and 36 6/7 weeks in gestation. Foetal Growth Restriction refers to a foetus with a birth weight less than the 10th percentile. Previous uterine surgery was defined as previous uterine surgery, such as myomec- tomy, excluding prior caesarean section; malpresentation includes breech presentation, face presentation, trans- verse lie, and unstable lie. Gestational Diabetes Mellitus refers to abnormal glucose tolerance occurring or ini- tially found during pregnancy by oral glucose tolerance test with any single blood glucose at or above the fast- ing,1 and 2 h values of 5.1, 10.0, 8.5 mmol/L (92, 180,153 mg/dl), respectively. Obesity in China is defined

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Competence and expertise in physiological breech birth

Competence and expertise in physiological breech birth

consistent with a physiological VBB approach may be facilitative, using judicious guidance to contribute to physiological optimisation, or they may be responsive to a perceived problem. In contrast, although the result was borderline, the panel did not reach a consensus-level agreement around the view that antenatal screening … has a significant impact on the safety of VBB, nor did they recommend stricter screening criteria as a means of reducing risk where available skill and experience were minimal. The results in the first principles category emphasised relationship, such as within the mother-baby unit and with caregivers, and response, such as the experienced attendant’s on-going assessment of steady progress. They de-emphasised models of care based on prediction of risk, the foundation of antenatal screening, and control, such as further limiting the ability of women to access VBB based on narrower selection criteria, although this strategy is a mainstay of national- level breech delivery guidelines ((Kotaska et al., 2009; RCOG, 2006).

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Original Article What is the relationship between the breech presentation and hip dysplasia? An experimental study on a rat model

Original Article What is the relationship between the breech presentation and hip dysplasia? An experimental study on a rat model

Abstract: The relationship between breech presentation and Developmental Dysplasia of the Hip (DDH) had been demonstrated through epidemiological methods, but the mechanism of such correlation and the pathological pro- cess of breech-related hip dysplasia remain unclarified. The purposes of this study were: (1) to establish an animal model to best simulate breech presentation; (2) to investigate how breech presentation influenced the severity of DDH and (3) to analyze the pathological development of the acetabulum and the femoral head. Newborn rats were swaddled to keep the hip flexed and knees extended to simulate human breech presentation. At 0, 2, 4, 6, 8 day after birth the specimen of the rats was stained and postero-anterior pelvic picture of the rat skeletons were taken to observe the relationship of the acetabulum and the femoral head. Sections of the hip were stained with Safranin O-Fast Green to assess the histopathologic changes of the acetabulum and the femoral head. In the pel- vic pactures, cartilage acetabular index (CAI), center-edge angle (CEA) and acetabular diameter/depth ratio (D/D) were measured. The incidence of DDH increased and the severity aggravated with the swaddling time. CAI in the experiment group was significantly larger than that of the control group since day 2. CEA decreased with time in the experiment group, while D/D increased obviously. Pathological changes of the hip joint emerged in the early stage of breech presentation, and aggravated with growth. Lateral bending of the ischium and thinner articular cartilage were observed in the dysplastic hips. In conclusion, the more time in breech position, the more incidence and sever- ity of DDH. Breech-related DDH was a chronic process that proceeded from mild dysplasia to subluxation and then to frank dislocation.

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Informed consent to breech birth in New Zealand

Informed consent to breech birth in New Zealand

Given apparent inadequacies in current practice, this article considered the legal duties of New Zealand providers to give information and to obtain consent in the management of breech presentation. The provider must give information about the risks and benefits of ECV, planned VBB and planned caesarean section (either before or during labour). Women have the legal right to refuse consent to caesarean section, in which case providers must deliver reasonable care in the circumstances. In order to respect women’s legal rights, consideration should be given to any necessary changes to educational requirements and institutional arrangements to facilitate real choice for women and safe care for VBB in the New Zealand maternity care system.

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Unexpected breech: what can midwives do?

Unexpected breech: what can midwives do?

We frequently speak with midwives distressed at the minimal amount of counselling and support women receive when a breech is diagnosed in labour. Why is this assumed to be the responsibility of the junior doctor who happens to be on duty? Midwives are equally responsible for ensuring that women receive complete and unbiased information. The Royal College of Obstetricians and Gynaecologist (RCOG) guideline (2006) as well as most Trust guidelines which follow them provide very specific information which women should receive, including:

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Women’s experiences of planning a vaginal breech birth in Australia

Women’s experiences of planning a vaginal breech birth in Australia

differences in their rating of staff, quality of intrapartum care or involvement in decision-making. Only two small qualitative studies have examined planning a vaginal breech birth [22-24]. In Jamaica [23], a study of nine women found that experiences were affected by the level and timing of information about breech presenta- tion. In Switzerland, a study of 12 women [24] found that a supportive environment and shared decision-making were important. Recently, the dilemma of breech birth has been highlighted in The Lancet with calls to improve the quality of education about vaginal breech birth and to listen to what pregnant women have to say [25]. There- fore, the aim of this study was to explore the experi- ences of women who had planned a vaginal breech birth in Australia in the preceding seven years.

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Classification of uterine EMG signals using supervised classification method

Classification of uterine EMG signals using supervised classification method

Aim: The main purpose of this article is to detect any risk of preterm deliveries at an early gestation period using uterine electromyography signals. Detecting such uterine signals can yield a promising approach to determine and take actions to prevent this poten- tial risk. Methods: The best position for the detection of different uterine signals is the median vertical axis of the abdomen. These signals differ from each other by their frequency content. Initially, simulation is done for the real detected EMG signals: preterm de- liveries (PD) EMGs and deliveries at term (DT) EMGs. This is performed by applying autoregressive model (AR) of specific order to estimate AR coeffi- cients of these real EMG signals. Finally, after calcu- lation of the AR parameters of the two types of de- liveries, we generate two types of simulated uterine contractions by using White Gaussian Noise (WGN). Frequency parameter extraction and classification are first applied on simulated signals to test the limits and performance of the used methods. The last re- maining step is the classification of the contractions using supervised classification method. Results: Res- ults show that uterine contractions may be classified using the Artificial Neural Networks (ANNs). The Si- mple Perceptron ANN is applied on the signals for their supervised classification into independent grou- ps: preterm deliveries (PD) and deliveries at term (TD) according to their frequency content.

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From therapeutic to elective cesarean deliveries: factors associated with the increase in cesarean deliveries in Chiapas

From therapeutic to elective cesarean deliveries: factors associated with the increase in cesarean deliveries in Chiapas

Background: Cesarean deliveries have increased over the past decade in Mexico, including those states with high percentages of indigenous language speakers, e.g., Chiapas. However, the factors contributing to this trend and whether they affect indigenous languages populations remain unknown. Thus, this work aims to identify some of the factors controlling the prevalence of cesarean sections (C-sections) in Chiapas between the 2011 – 2014 period. Methods: We analyzed certified birth data, compiled by the Subsystem of Information on Births of the Secretary of Health and the National Institute of Statistics and Geography, and information regarding the Human Development Index (HDI), assembled by the United Nations Development Program. A descriptive analysis of the variables and a multilevel logistics regression model were employed to assess the role of the different factors in the observed trends.

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A retrospective study to correlate breech presentation and enhanced risk of postspinal hypotension during cesarean delivery

A retrospective study to correlate breech presentation and enhanced risk of postspinal hypotension during cesarean delivery

Patients and methods: The study was conducted on pregnant females scheduled for a lower segment cesarean section between January 2014 and December 2014. After applying inclusion criteria, 568 patients were recruited in the study out of which 363 had vertex and 184 patients had breech presentation. They were divided into two groups, Group I and Group II. The moni- toring and therapeutic data (blood pressure, heart rate, arterial oxygen saturation, and dose of vasopressor/atropine) recovered from automated data analysis were analyzed retrospectively for prevalence of hypotension, bradycardia, and hypotension with bradycardia and nausea ± vomiting.

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Owner’s Manual for the Rossi Muzzleloading Rifle & Muzzleloading Matched Pair

Owner’s Manual for the Rossi Muzzleloading Rifle & Muzzleloading Matched Pair

WARNING: A primed muzzleloading rifle must be handled with extreme care. The muzzle must be kept pointed in a safe direction and the fingers kept well clear of the trigger and trigger guard. A primed muzzleloading rifle is one step away from firing and should never be set down or carried any distance. If you must carry the firearm after priming, open the breech, remove the primer and carry the rifle with the breech open. Breech Plug: The screw-in plug at the receiver or breech end of the barrel. This breech plug effects the seal and serves as the primer carrier. WARNING: After removing the breech plug, clean away any powder grains that may be in the barrel threads before attempting to reinstall the plug. Black powder can be ignited from the friction of screwing in the plug, and can result in accidental death or serious injury.

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A Prospective Clinical Study of Babies born with Meconium Stained  Liquor Delivered by Caesarean and Pervaginal Delivery

A Prospective Clinical Study of Babies born with Meconium Stained Liquor Delivered by Caesarean and Pervaginal Delivery

Introduction: Meconium staining of the amniotic fluid (MSAF) is a common problem occurring in 11-22% of all deliveries. Yoder et al documented a decline in the incidence of MAS from 5.8% to 1.5% over the period 1990 to 1997, which they attributed to 33% reduction in the incidence of births at more than 41 weeks gestation. MAS remains a serious problem in developing and newly industrialized countries, MAS accounts for about 10% of all cases of respiratory failure with 39% mortality rate. It has been attempted to identify antepartum, intrapartum or postpartum factors that may increase the risk for MAS. Over the years various recommendations also have been made based on these studies to identify and anticipate the occurrence of MAS in neonates born through MSAF, so that early intervention can be done

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