Management of term breech presentation.
The management of 716 cases of singleton breech presentation occurring at 37 or more weeks of gestational age is reviewed. Beginning in 1980 a trial of external version was offered if the breech was identified before active labor. Only 433 (61%) breeches were identified before active labor. Of these, 171 (44%) underwent an attempt at external version and 83 (48%) were successful. The 623 cases remaining as breech presentation were stratified into three groups: cesarean section without labor (379), trial of labor with cesarean section (69), and trial of labor with vaginal delivery (175). The criteria for allowing a trial of labor are detailed. Careful review of maternal and fetal variables indicates that a trial of labor in selected patients will result in vaginal delivery in 72% and that this can be achieved without an increase in fetal or maternal mortality or morbidity. Furthermore, successful external version followed by a trial of labor in selected cases is highly cost-effective.
D001946:Breech Presentation; D002585:Cesarean Section; D003362:Cost-Benefit Analysis; D036861:Delivery, Obstetric / Q000191:economics; D005260:Female; D005865:Gestational Age; D006801:Humans; D007743:Labor, Obstetric; D007902:Length of Stay; D008954:Models, Biological; D011247:Pregnancy; D013223:Statistics as Topic; D014710:Version, Fetal