PubMed · 12969931
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Andrew H Shennan. 2003-09-13. Recent developments in obstetrics.. https://doi.org/10.1136/bmj.327.7415.604
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We performed a retrospective study of all patients referred for external cephalic version (ECV) at > or = 36 weeks gestation from 1993 to 2000. Exclusion criteria included ominous fetal heart rate changes, complete or multiple loops of nuchal umbilical cord, extension of the fetal head, oligohydramnios and poorly controlled hypertension. Three groups were compared: spontaneous cephalic version (SCV), ECV attempted (ECV) and ECV not attempted (NoECV). A total of 289 patients were referred. ECV was attempted in 191, 118 by one operator (D.W.S.). ECV was successful in 98/191 (51%) attempts. Spontaneous reversion to breech after successful ECV occurred in 6/98 (6%). There were 4 complications: 1 occult cord prolapse, 2 nonreassuring fetal heart patterns, and 1 placental abruption; all led to nonemergent cesarean delivery (CD). The CD rate (SCV 2/18, 11%; ECV 114/179, 64%; NoECV 49/51, 96%) was highest in the no-attempt group (p=0.001). The CD rate after successful ECV was 29/91 (32%). Maternal postdelivery complications (SCV 1/16, 6%; ECV 24/161, 15%; NoECV 13/48, 27%) and neonatal complications were not significantly different. With careful attention to contraindications, ECV can be performed with few complications. ECV lowers the CD rate.
BACKGROUND: Women's right to decide on the mode of delivery is discussed, as well as the management of term breech deliveries. Obstetric practice may have changed as a consequence of ongoing debates. National caesarean section rates were stable at 12-13% during the 1990s, but no information has been provided about the development over the last two years. MATERIAL AND METHODS: Information about deliveries in obstetrical units in Norway, 1999 to 2002, was extracted from the Norwegian Patient Register. The number of deliveries was validated against information from Statistics Norway. The numbers of caesarean sections in 1999 and 2000 were validated against information from the Medical Birth Registry of Norway. RESULTS: The caesarean section rate increased slightly from 12.8% in 1999 to 13.0% in 2000. In 2001, there was a considerable increase to 14.9%; during the first 8 months of 2002, the rate was 15.1%. The change in practice appeared in the last months of 2000, coinciding with the publication of the term breech trial. However, only about one third of the increase can be attributed to a change in breech delivery. COMMENTS. Caesarean section is the most frequent major surgical procedure performed on hospitalised patients. In times of rapid changes in obstetric practice, monitoring of the development without time delay is called for.
OBJECTIVES: To compare neonatal morbidity of breech and cephalic deliveries at term. STUDY DESIGN: Cohort study of 610 consecutive singleton breech presentations and 12,405 consecutive singleton cephalic presentations in term between 1992-1998. Five hundred and fourteen breech and 11,989 cephalic presentations were candidates for vaginal delivery, of which 407 (79%) breeches and 11,265 (94%) cephalic delivered vaginally. RESULTS: Neonatal intensive care admissions were significantly greater for breech than cephalic vaginal deliveries (2.7% versus 0.25%, P = 0.000), but newborn intensive care admission and mortality were equally distributed between the two groups. CONCLUSIONS: A low caesarean rate is possible (21% beech and 6% cephalic). Neonatal morbidity was equal in the two populations. Admission to neonatal intensive care was significantly more frequent for caesarean section than for vaginal delivery in the cephalic group and equal in the breech group. This study justifies our obstetrical policy and the realisation of a trial in several centres similar in terms of perinatal management.