title: [What effect does leg position in breech presentation have on mode of delivery and early neonatal morbidity?].
abstract: The objective of the present study is to establish whether the position of the legs in breech presentation deliveries affects the vaginal or abdominal mode of surgical delivery and the early neonatal morbidity. The patient population investigated (n = 266) comprised 163 primiparae (61.3%) and 103 multiparae (38.7%). Of the 266 term infants (more than 37 complete WOP) with breech presentation, 71.3% (127/178) could be delivered vaginally from a simple pelvic presentation and 55.3% (42/76) from an incomplete or complete footling presentation. The average duration of labor was 460 minutes in a pelvic presentation delivery, and 400 minutes in a footling presentation delivery. The rate of acidosis (pHNA < 7.20) was 26% in the neonates delivered from the pelvic presentation as compared to 11.9% in the footling presentation deliveries. The number of neonates with a 5/10 minute APGAR score of seven points was 0/0% in pelvic and 4.8/2.4% in footling presentation. Of the neonates delivered from pelvic presentation, 10.2% (13/127) were moved to the neonatology department as compared to 14.3% (6/42) babies delivered from footling presentation. A secondary Cesarean section was indicated in 28.7% of pelvic presentation deliveries commenced vaginally (51/178) and in 44.7% of the footling deliveries (34/76). The rate of acidosis was 49% (25/51) in the babies with pelvic presentation and 21% (7/34) in the babies with footling presentation. The percentage of neonates with respiratory depression (5/10 minute APGAR score < 7 points) was 3.9/2.9% in the babies delivered from pelvic presentation and 2/0% in the babies delivered from footling presentation. Correspondingly, the rate of transfer to the neonatology ward was extremely high: 33.3% (17/51) of the pelvic presentation babies and 8.8% (3/34) of footling babies. In 11 pregnant women (5.8%) with a fetus in pelvic presentation, a primary Cesarean section was indicated, in half of these cases (n = 5) because of "suspicion of a discrepancy", three times at request of the patients and three based on fetal and on maternal indication. Because she had rejected vaginal delivery, primary Cesarean section was performed in one pregnant mother (1.3%) with a fetus in footling presentation. Fetuses with simple pelvic presentation at term were more frequently delivered vaginally than fetuses in footling presentation (71.3% compared to 55.3%). The rate of respiratory acidosis was higher in the neonates with pelvic presentation than those with footling presentation (26% as compared to 11.9%). They compensated this acidotic metabolism within a short time, so that the transfer to the neonatology ward was only temporary. The same applied to the babies delivered by secondary Cesarean section.
authors.affiliation: Frauenklinik II, Klinikum Nürnberg Süd.
authors.forename: M
authors.initials: M
authors.lastname: Krause
authors.forename: T
authors.initials: T
authors.lastname: Fischer
authors.forename: A
authors.initials: A
authors.lastname: Feige
mesh_terms: D000328:Adult; D001238:Asphyxia Neonatorum / Q000209:etiology*; D001946:Breech Presentation; D002585:Cesarean Section; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007866:Leg; D010298:Parity; D010387:Pelvimetry; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors