Vaginal Delivery of Breech Baby Safe Under Specific Circumstances
Reuters Health Information 2006. © 2006 Reuters Ltd.
By Martha Kerr
NEW YORK (Reuters Health) May 12 - Neonatal outcome of planned vaginal
deliveries of breech presentations is virtually the same as the outcome of
planned cesarean delivery if strict criteria are met, including pelvimetry
and management of labor.
Investigators with the PREsentation et MODe d'Accouchment (PREMODA,
presentation and mode of delivery) study, led by Dr. Francois Goffinet of
the Universite Pierre et Marie Curie in Paris, conducted a prospective study
with intent to treat analysis with 2526 women with planned vaginal delivery
and 5579 planned cesarean delivery of breech presentations. The main outcome
measure was fetal and neonatal mortality combined with severe neonatal
morbidity.
Of the women planning vaginal deliveries, 71.0% were successful. The rate of
the combined adverse outcome was 1.59%. Of the 5,579 planned cesarean
deliveries, the combined adverse outcome was about the same, at 1.60%.
Strict criteria had to be met to follow through with a planned delivery, Dr.
Goffinet pointed out. Pelvimetry was used by 82.4% of physicians in the
PREMODA study compared with 9.8% of physicians in comparable settings in
national registries. Continuous fetal heart rate monitoring was also
performed in the planned vaginal delivery group.
A second stage of labor longer than 60 minutes, a significant cause of
neonatal complications, occurred in only 0.2% of the planned vaginal
delivery group, Dr. Goffinet noted. Active pushing before the presenting
part reached the pelvic outlet was used by the PREMODA physicians, which is
earlier than recommended in French practice guidelines.
Four of infants of planned vaginal deliveries had Apgar scores below four at
5 minutes compared with 1 in the planned cesarean section group.
Dr. Goffinet told Reuters Health that complications to the infant and the
mother are higher if a rescue cesarean delivery is needed after the baby is
engaged, but that the risks are about the same as an infant engaged in a
women with a planned cesarean section.
These results are published in the April issue of the American Journal of
Obstetrics and Gynecology.
Am J Obstet Gynecol 2006;194:1002-1011.
Leanne Wynne
Midwife in charge of "Women's Business"
Mildura Aboriginal Health Service Mob 0418 371862
--
This mailing list is sponsored by ACE Graphics.
Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
