Cesarean or vaginal delivery for the breech fetus at the threshold of viability: results from a maternal-fetal medicine specialists survey.
OBJECTIVE
To determine how United States Maternal-Fetal medicine specialists recommend delivery of a breech fetus at the threshold of viability.


METHODS
U.S. Society for Maternal-Fetal Medicine (SMFM) members were surveyed about; geographic location, practice type, whether they performed deliveries, definition of threshold for viability, recommendations for delivery of a breech fetus at the threshold of viability, and if the current medical-legal climate had any bearing on their decisions. Chi-Square and Fisher's Exact tests were used for analysis.


RESULTS
510 SMFM members responded to the questionnaire. The highest percentage of respondents stated '23 weeks' (31%) as the cutoff for viability, followed by '24 weeks' (21%) and '23 weeks or 500 g' (10%). Seventy percent recommended cesarean delivery for a breech fetus at the threshold of viability. The majority of respondents based their decision on 'published data' or 'expert opinion', however, 58.6% reported they felt current medical evidence was inadequate to support a recommendation. Fifty-three percent stated their recommendations are affected by medical-legal concerns.


CONCLUSIONS
The majority of U.S. maternal fetal-medicine specialists who responded would recommend cesarean delivery for a breech fetus at the threshold of viability, despite the belief that there is inadequate evidence in the literature to support this recommendation.
Deutsch
Aaron B
AB
Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of South Florida College of Medicine, Tampa, FL 33606, USA. abdmd2003@hotmail.com
Duncan
Karen
K
Rajaram
Lakshminarayan
L
Salihu
Hamisu M
HM
Spellacy
William N
WN
Belogolovkin
Victoria
V
D000328:Adult; D001946:Breech Presentation / Q000628:therapy*; D002585:Cesarean Section / Q000706:statistics & numerical data*; D002755:Choice Behavior / Q000502:physiology; D003625:Data Collection; D003657:Decision Making; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005328:Fetal Viability / Q000502:physiology*; D006801:Humans; D033261:Maternal-Fetal Relations; D009774:Obstetrics / Q000379:methods* / Q000706:statistics & numerical data; D011247:Pregnancy; D011364:Professional Practice; D014621:Vagina