| 20031126-16# Breech deliveries and
cesarean section - Journal
of Perinatal Medicine , vol 31, no 5, 2003, pp 415-419 Papp
Z - (2003) |
| |
Breech presentation is the most common
malpresentation, with about 3-4% of singleton fetuses presenting breech at
delivery. Management of breech presentation has been a contentious issue
with a lowering threshold for cesarean section in recent years. Perinatal
mortality and morbidity are estimated to be three times that of comparable
infants with vertex presentation. Breech presentation is commonly
associated with certain adverse maternal and fetal factors which
inherently give rise to increased perinatal morbidity and mortality. At
present, most obstetricians favor cesarean delivery for uncomplicated
pre-term breech. Controlled prospective studies have shown that the
outcome of breech fetuses weighing more than 1500 g was not dependent on
the mode of delivery. A more recent review from the Cochrane database by
Grant does not justify a policy of elective cesarean section for pre-term
breech. Vaginal delivery is preferred if the following criteria are met:
frank breech only, estimated fetal weight of 2500-3500 g, adequate
pelvimetry without hyperextended head, normal progression of labor, no
evidence of fetal hypoxia under continuous fetal monitoring, and maternal
weight under 90 kg. Vaginal delivery of frank breech at term may be just
as safe as cesarean section when careful selection criteria are used. If
these criteria are not fulfilled, or fetal monitoring cannot be performed,
cesarean section is advisable. (21 references)
(Author) |
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