How perinatologists manage the problem of the presenting breech.
A questionnaire regarding controversies in management of the breech presentation was answered by 405 maternal-fetal medicine subspecialists. Legal concerns strongly influenced clinical management in 63% of respondents. External cephalic version was considered both safe and effective in 90 and 83% of respondents, respectively. Three-quarters of those who responded usually allow a trial of labor in selected term frank breech presentations. Of the respondent subset, 43% usually augment hypotonic contractions with oxytocin. Only 57% agreed there was sufficient literature to favor cesarean section for the 28 to 31 weeks breech presentation, and only 43% so agreed for the 32 to 34 week frank breech. Nevertheless, in these situations, 94 and 83%, respectively, actually perform cesarean section in clinical practice. More than 75% agreed that a prospective study is needed to determine the correct delivery mode of the preterm breech. Ninety-two percent agreed that such data could change their current opinion regarding delivery management. Implications are discussed.
Amon
E
E
Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri 63110.
Sibai
B M
BM
Anderson
G D
GD
D001946:Breech Presentation; D002585:Cesarean Section; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D006801:Humans; D010500:Perinatology / Q000379:methods*; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D012307:Risk Factors; D012955:Societies, Medical; D011795:Surveys and Questionnaires; D014219:Trial of Labor; D014481:United States