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20040308-10 Singleton vaginal breech delivery
at term: still a safe option - Obstetrics and Gynecology , vol 103, no 3, March 2004, pp
407-412 Alarab M; Regan C; O'Connell MP; et
al - (2004) |
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OBJECTIVE: To examine the obstetric and perinatal
outcome of pregnancies with singleton breech presentation at term when
selection for vaginal delivery was based on clear prelabor and intrapartum
criteria. METHODS: The outcomes of all pregnancies with a breech
presentation after 37 weeks of gestation were retrospectively reviewed
from January 1997 to June 2000. Criteria for prelabor cesarean or trial of
vaginal breech delivery included type of breech, estimated fetal weight
(more than 3,800 g), maternal preference, and gestation more than 41
weeks. An intrapartum protocol excluded induction and oxytocin
augmentation of labor, combined with a low threshold for cesarean delivery
for dystocic labor; an experienced obstetrician was in attendance during
labor and delivery. RESULTS: Of 641 women, 343 (54%) underwent prelabor
cesarean, and 298 (46%) had a trial of vaginal delivery, of whom 146 (49%)
delivered vaginally. Significantly fewer nulliparas (58 of 158, 37%) than
multiparas (88 of 140, 63%; P <.001) achieved vaginal delivery after
trial of labor. Significantly more infants weighing more than 3,800 g were
selected for prelabor (87 of 343, 25%) and intrapartum (31 of 152, 20%)
cesarean than delivered vaginally (15 of 146, 10%). Two neonates (0.7%)
had Apgar scores of less than 7 at 5 minutes; both were neurologically
normal at 6 weeks. There were no nonanomalous perinatal deaths and no
cases of significant trauma or neurological dysfunction; 3 infants
delivered vaginally died due to lethal anomalies. CONCLUSION: Safe vaginal
breech delivery at term can be achieved with strict selection criteria,
adherence to a careful intrapartum protocol, and with an experienced
obstetrician in attendance. Our protocol effectively selects larger
infants for cesarean delivery. (25 references)
(Author) |
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