Controversies: selective vaginal delivery for breech presentation.
Within two last decades many centers have adopted a policy of abdominal delivery, in particular of nulliparous women with breech presentations. In this review of the literature the justification for this policy is questioned. Instead, a recommendation for judicious attempts of vaginal delivery for some breech presentations is emphasized. The maternal complication rates associated with Cesarean deliveries are remarkable higher than those of vaginal deliveries. The list of contraindications to vaginal breech delivery include: feto-pelvic disproportion, hyperextension of the fetal head, umbilical cord presentation, objection on the part of the mother. Relative contraindications include a fetal weight of less than 1500 g, footling presentation, and premature rupture of membranes with a unripe cervix. Overall meta-analysis of the literature gives as neonatal mortality and morbidity rate which is 4 times higher after vaginal breech delivery than after Cesarean delivery. The majority of the studies are non-randomized, comparative and descriptive. In two randomized studies of term breeches, no differences in neonatal outcome was found when Cesarean deliveries were compared to vaginal deliveries. A universal policy of Cesarean delivery of breech presentations may lead to unnecessary maternal complications without any benefit to the fetus or newborn. It is reasonable to assume that about 40% of breech presentations could be delivered vaginally without endangering the neonatal outcome.
Erkkola
R
R
Department of Obstetrics and Gynecology, University Central Hospital, Turku, Finland.
D001946:Breech Presentation; D002585:Cesarean Section / Q000009:adverse effects; D036861:Delivery, Obstetric; D005260:Female; D005322:Premature Rupture of Fetal Membranes; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D011247:Pregnancy; D011256:Pregnancy Outcome; D014710:Version, Fetal