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Breech Delivery

The rate of cesarean delivery for fetuses with intrapartum breech presentation now exceeds 90%. Of the remaining 10%, some are delivered vaginally before cesarean delivery can be performed breech delivery, breach. Only a small percentage of patients elect to undergo a trial vaginal breech delivery. Criteria for vaginal breech delivery at term include an adequate maternal pelvis, frank breech presentation without hyper-extension of the fetal head, and an estimated fetal weight between

There is a critical shortage of patients for both residency training and maintenance of delivery skills in the management of vaginal breech deliveries. Furthermore, there are no prospective randomized trials with sufficient power to demonstrate differences in uncommon adverse neonatal outcomes. A large meta-analysis of breech presentation at term reviewed perinatal outcome in 24 studies according to the intended mode of delivery. The overall neonatal morbidity from trauma was 

Studies regarding the safety of preterm breech vaginal delivery are conflicting. Efforts to perform randomized, prospective trials with proper power have been resisted by patients, practitioners, and

or example, the Maternal-Fetal Medicine Units Network of the National Institute of Child Health and Human Development declined to undertake a trial of cesarean versus vaginal breech delivery at 24-28 weeks of gestation because the trial would take 8-9 years to complete in an 11-member, multicenter network with 60,000 annual deliveries. Ironically, 82% of the faculty of the Maternal-Fetal Medicine Units Network agreed that such trials were needed, and 55% thought that residency training for vaginal breech delivery was

Because it seems unlikely that the question will be answered in the 1990s, only nonselective and retrospective data are available to justify vaginal breech delivery for the term and preterm infant. External cephalic version at term is an alternative to vaginal breech delivery that can decrease term breech presentation by

External Cephalic Version

Four randomized, controlled trials of external cephalic version at term have been conducted (only one in the United States) to evaluate the safety and efficacy of this intervention. All four showed a reduction in the incidence of both intrapartum breech presentation and cesarean delivery rate. In the United States, it has been suggested that a program of external cephalic version at term would lower the cesarean delivery rate for breech presentation from 83% to 37%. Attendant cost savings would also be realized.

External cephalic version should be performed in accordance with established guidelines:

Reactive NST should be obtained before and after the procedure.

Ultrasonography should be done before the procedure to confirm presentation, assess amniotic fluid volume, and exclude placenta previa.

Ultrasonography can be used during external cephalic version to monitor both FHR and the progress of the procedure.

External cephalic version should be performed in or very near the labor and delivery suite because immediate delivery might be