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PubMed · 3564757

[External version from breech position to head presentation near term].

K D Ketscher·U Retzke·J Kindt
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Abstract

The external version of fetus from breech into a head presentation is one of the methods to avoid maternal and fetal risk by Cesarean section and by vaginal delivery. As a supposition, we see a technique which is undangerous for mother and fetus. Our procedure corresponds in many points with a practice, which is published by B. Westin. The sober patient is positioned head down on the side of fetus small parts. Then an intravenous infusion is given over 30 min with 2 micrograms fenoterol (Partusisten)/min. The version is performed in many single and little steps. It needs time, a soft hand and the readiness of the Cesarean section. In 104 of 242 patients with breech presentation there was the indication with fulfilled suppositions for such a version. The success-rate was nearly 50%. In no case there was a complication. The rate of Cesarean section past turning was clearly reduced in contrary to breach presentation. The fetal outcome was clearly better. The version of breach presentation is recommended.

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Breech PresentationCesarean SectionDelivery, ObstetricFemaleFetal MonitoringHumansInfant, NewbornObstetric Labor ComplicationsPregnancyRiskVersion, FetalEnglish AbstractJournal Article

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K D Ketscher, U Retzke, J Kindt. 1987. [External version from breech position to head presentation near term].. https://pubmed.ncbi.nlm.nih.gov/3564757/

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PubMed2006

[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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