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PubMed · 11525084

[Term breech presentation: an indication for cesarean section].

F J Roumen·J G Nijhuis
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Abstract

The results of the 'Term breech trial' (carried out at 121 centres in 26 countries, and in which 2088 women with a singleton foetus in breech presentation were randomly assigned to planned caesarean section or planned vaginal birth) indicate that in countries with low perinatal mortality rates, planned vaginal birth was associated with serious neonatal morbidity at least 12.5 times more often than was the case for planned caesarean section. The trial is methodologically sound. Unfortunately, no information on long-term neonatal morbidity is provided and the study is too small to assess maternal mortality. Moreover, the study provides no information on the consequences of a uterine scar for future pregnancies. However, as there are no other data from studies in the Netherlands, the results from this trial also have a bearing on Dutch practice. The pregnant mother of a term breech baby should be carefully informed about the results of this trial, prior to the preferred means of delivery being decided upon in consultation with her. A deliberate choice for an elective caesarean section based on a mere breech presentation is justified.

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Breech PresentationCesarean SectionFemaleHumansInfant, NewbornInfant, Newborn, DiseasesInformed ConsentMulticenter Studies as TopicNetherlandsPractice Guidelines as TopicPregnancyRandomized Controlled Trials as TopicJournal ArticleReview

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BibTeXRIS

F J Roumen, J G Nijhuis. 2001-08-11. [Term breech presentation: an indication for cesarean section].. https://pubmed.ncbi.nlm.nih.gov/11525084/

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[Is there a role for X-ray pelvimetry in the twenty-first century?].

The purpose of this article was to perform a critical analysis of publications having estimated the utility of X-ray pelvimetry, in order to allow tangible and useful conclusions for the clinical practice. X-ray pelvimetry was proposed in 3 indications: trial of labour among patients with a history of caesarean section, breech presentation, suspicion of cephalopelvic disproportion. The large majority of these publications are retrospective studies, studying a low number of patients and especially without control groups or randomisation. Their contradictory results and their methodological weaknesses do not allow any conclusion. Published randomised trials are exceptional. Among patients with a history of caesarean section, there is only one randomised trial; it demonstrates that ante-partum X-ray pelvimetry is not necessary prior to a trial labour in women with one previous caesarean section. It increases the caesarean section rate and is a poor predictor of the outcome of labour. There is also only one randomised trial which evaluated the interest of X-ray pelvimetry in patients with a breech presentation: the use of pelvimetry in breech presentation at term does not significantly reduce the overall caesarean-section rate, and does not improve the neonatal issues. However, it allows better selection of the delivery route, with a significantly lower emergency Caesarean-section rate. Finally, the only one randomised trial having studied the utility of X-ray pelvimetry for the prediction of cephalopelvic disproportion shows that pelvimetry is a poor predictor of the outcome of labour, has no influence on the neonatal issues and increases the caesarean sections rate. Furthermore, although radiation exposure during a X-ray pelvimetry is very weak, diagnostic X-ray studies during any stage of gestation have been shown to increase the risk of childhood cancer in the irradiated fetus. In the rare cases where pelvimetry is useful (trial of labour with a breech presentation), it is thus careful to perform a MRI pelvimetry.

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PubMed2006

French trainees in obstetrics and gynaecology theoretical training and practice of vaginal breech delivery: a national survey.

OBJECTIVE: To survey French trainees in Obstetrics and Gynaecology and evaluate their theoretical training and practice of vaginal breech delivery (VBD). STUDY DESIGN: We conducted a national survey between January and April 2004 among the 817 French trainees undergoing a 5-year training program in obstetrics and gynaecology. Trainees in years 1-3 were considered as juniors, and those in years 4 and 5 as seniors. Respondents were invited to specify whether they had received theoretical teaching in the management of VBD, and to indicate the number of VBDs they had performed during their training. RESULTS: The questionnaire was returned by 156 (19%) trainees and of these 140 questionnaires were suitable for analysis. Overall, 35% of the respondents had never been taught the management of a VBD. Among the senior trainees, 33% had performed less than four VBDs, and 23% had not received any teaching on how to manage a VBD. CONCLUSION: The level of theoretical training and practice in the management of VBD seems to have diminished and does not bring the French trainees in obstetrics and gynaecology to the required standard of competence.

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