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[Are more girls than boys born in breech presentation compared with head presentation?].

In breech presentations a little more girls are born than boys, among head presentations there is a slight excess of boys. Among the factors favoring pelvic presentation birth weight has, according to present investigations, a decisive influence on the different sex relationship in the two presentations. Boys are little more common than girls in head presentation in the higher weight groups, in breech presentation in the upper and lower weight groups, while girls predominate in the middle weight groups. The absolute size of the middle weight groups in breech presentation causes the small excess of girls. A possible link with the slightly higher mortality of boys during the first year and its higher incidence in very high and very low weight groups are discussed as well as the dependence of the production of breech presentation on weight and mobility of the fetus.

Birth Weight

[Vertex presentation in the morning--breech presentation at noon: a nursery tale? A prospective study of 1,019 patients].

The percentage of breech presentations in the course of the 32nd to 40th week of gestation is 5.1%; vertex presentations were found in 94.9%. In the primiparae we found 6.0% of breech presentations against 4.3% in the multiparae. Sub partu there were breech presentations in 4.5% (in primiparae more often than in multiparae). A spontaneous change from vertex- into breech presentation from the 32nd to 40th week of gestation was evident in 4 cases = 0.41% [in the primiparae (n = 484) in one case = 0.21%; in the multiparae (n = 531) in 3 cases = 0.59%]. A change from breech presentation (n = 52) into vertex presentation occurred in the same period in 9 cases = 17.31% [in primiparae (n = 29) in 10.34%, in multiparae (n = 23) in 26.09%; the difference is statistically not significant!] All cases of change from vertex- into breech presentation were seen until the 35th week of pregnancy, not later, whereby the cases of change from breech- into vertex presentation happend until the 36th week of pregnancy (except one "late" change in the 39th week in a multipara), in the primiparae until the 36th week, in the multiparae until the 35th week of gestation. Thus, apart from rare exceptions, the definite birth-presentation of the fetus has taken place about the 35th/36th week of gestation. Late changes of position of the fetus are not likely. A diagram with the exact percentages and likelihood of changes of the fetus presentation for primi- and multiparae between 32nd and 40th week of gestation is given.

Birth Weight

[Analysis of 290 breech presentations].

By analysing all breech presentations handled in the last three years (290 cases), the authors have found that perinatal mortality in such cases was much higher (8%) than the general perinatal mortality (1.8%) in the last years and that this increase mainly related to the perinatal mortality of children weighing less than 2500 g, owing to complications and diseases typical of that kind of children. Out of the children delivered with breech presentation, 40% were either premature babies (22%) or small-for-date babies (18%). The condition of children delivered with breech presentation is 5-6 times worse than in premature babies delivered with full or partial extraction. The authors could not establish if the condition of children with cesarean section was better. The results were obtained when the delivery was induced by using the maniotomy and Syntocinon. The authors point out that the problem of breech presentation lies in prematurity, that an excessive application of cesarean section does not solve the problem, that extractions should be avoided, and that all such deliveries should be managed on the principle of active management of labour.

Apgar Score

[Perinatal problems in breech presentation].

543 cases of breech presentation at the 1st Clinic of Obstetrics and Gynecology of the University of Vienna were investigated. The rate of Cesarean section showed during the last years a distinct increase (1969 to 1973: 16,6%, 1974 to 1977: 27,9%, 1977: 39,7%). A significant decrease of perinatal mortality in cases of breech presentation was not observed. On the other hand an increase in Cesarean sections diminishes the rate of perinatal mortality. In this publication the findings concerning the obstetrical results using abdominal or vaginal delivery are compared. No significant difference in perinatal mortality could be found. A better result could only be achieved in cases of mature infants. Our point of view is, that at present the indication of Cesarean section for cases of breech presentation should be very liberal. On the other hand vaginal delivery in some cases is still of importance.

Abnormalities, Multiple

Delivery of breech presentation infants at term. An analysis of 304 breech-deliveries.

304 breech presentation infants greater than or equal to 2.500 g were delivered at the University Women's Clinic, Kiel, between 1984 and 1987. Only 2 of the vaginally delivered infants died; both had severe malformations sonographically diagnosed prior to delivery. The umbilical cord arterial PH was found to be significantly (p less than 0.001) higher in infants delivered per Caesarean Section as compared to those vaginally delivered. The same ratio was found in a control group of vaginally delivered infants compared to sectioned infants in the vertex presentation. In 13.3% of cases post primary section and in 14.4% of cases post vaginal delivery from breech presentation we found an apgar of less than or equal to 7 one minute post-partum. The transfer rate to a paediatric unit of vaginally delivered infants (7.2%) appeared to be double that of the infants delivered per Caesarean Section (3.6%). However, the indication for transferral is principally independent of the mode of delivery. Taking the 3-12fold increased maternal mortality rate post section as compared to vaginal delivery into consideration, a vaginal delivery of a breech presentation infant at term appears to be justifiable under certain presuppositions: exclusion of cranio-pelvic disproportion, and normal progression of labour. The indication for secondary Caesarean Section should be generously applied in cases of a suspicious C.T.G. and a slow progression of labour.

Breech Presentation

[Critical notes on delivery and perinatal mortality in single breech presentation deliveries].

This report deals with 432 single breech presentation deliveries. Caesarean section frequency was 12,3%. As to the vaginal route of delivery, the simple Bracht manoeuvre had been prefered; in recent times, however, the assisted spontaneous delivery with oxytocin-infusion has been introduced. The corrected perinatal mortality was 4,9%. The rate of prematurely born infants amounted to 14,6%. The corrected perinatal mortality of infants up to 2500 g was 3,3%; of full term infants it was 1,4%. The importance of breech presentation delivery as a high risk delivery is being emphasized. Fetal monitoring and blood gas analysis were required. Indications of caesarean section and suggestions for the management of breech presentations were established. Generally caesarean section of primiparae is not recommended. The diminished rate of prematurely born infants is considered to be of great importance for the decrease of perinatal mortality of breech presentation infants. Intensive pregnancy care, widely used uterotocolysis, and cervix-cerclage in cases of breech presentation are recommended.

Birth Weight

The intrapartum management of the breech presentation.

In many cases of breech presentation, a trial of labor is practical and safe among carefully selected parturients. Anesthesia and full neonatal support should be available. Described is the protocol in use at several large institutions that maintain a Cesarean rate for breech presentation in the 60 to 70 per cent range which is approximately 25 per cent lower than the national rate. The development of this protocol as well as its highlights in clinical application are described and highlighted in this report.

Breech Presentation

[Risks for neonates born in the breech presentation].

A prospective study included 106 females and their newborns, 45 of them born in breech presentation and 61 delivered normally. The incidence of prepathologic and pathologic CTG records and meconial amniotic fluid is significant (0.01), more frequent in breech presentation (24.44% and 22.2%) than in normal deliveries (8.20% and 9.84%). Children born in breech presentation have significantly (p < 0.005) lower Apgar score values after the 1st and 5th minute than the control children. Infants born in breech presentation have significantly (p < 0.01) lower pH values (7.25 +/- 0.093) than those delivered normally (7.30 +/- 0.056). The acidosis incidence (pH < 7.20) in the studied group was 26.66% and 3.38% in the control group. In early neonatal period the disease occurred in 35.55% of the breech presentation group and 9.83% of the normal group (p < 0.01). In the control group there was no intracranial hemorrhages and manifest cerebral disfunction--complications most frequently involved in perinatal morbidity of children born in breech presentation (17.77% and 8.88%). One (2.22%) child born in breech presentation died in the early neonatal period.

Breech Presentation

Extradural analgesia in labour when the breech presents.

A retrospective study was made of the course and outcome of labour in 226 patients in whom a singleton fetus presented by the breech. Patients with macerated stillbirths or who were delivered before the 28th week of gestation had been excluded. Of the 226 patients, 101 received extradural analgesia, 79 received parenteral analgesia and 46 underwent elective Caesarean section. There was no difference in the incidence of breech extraction or emergency Caesarean section in the first two groups of patients. The length of both first and second stages of labour in multiparae was prolonged in the extradural group, but not markedly so. The Apgar scores of the infants delivered vaginally were not significantly different at one minute in both groups but the five minute Apgar score in the infants of primiparae was significantly higher in the extradural group. The Apgar score at one minute in the group delivered by emergency Caesarean section was significantly lower after extradural block but the difference was not significant at five minutes. This study suggests that the management and outcome of labour when the breech presents is not adversely affected by the provision of extradural analgesia.

Adult

[Tocolysis for external version of breech presentation close to term (authors transl)].

The external version of breech presentation into vertex presentation with tocolysis near term is now the best method to avoid the disadvantages of a breech presentation for mother and child. In 30 out of 37 cases external version using Partusisten was possible. 26 patients with previous breech presentation were, after version, delivered of a healthy child. Except for one transitory slight hemorrhage there were no incidents. This method should be carried out only in a department having facilities for cardiotocography and emergency Caesarian section. It appears that a cause of failur of the external version with tocolysis near term is the breech presentation with extended legs.

Breech Presentation

Minimal brain dysfunction in children born in breech presentation.

The influence of delivery in breech presentation on the occurrence of minimal brain dysfunction (MBD) has been studied. Parents of 8--15 year old children were asked to account for behavioral and educational deficits and needs of their children from birth until the date of investigation. It was found that among prematurely delivered children, the frequency of MBD, defined as hyperkinesia and learning disability, amounted to about 20 per cent and was similarly distributed between children , however, the average frequency of hyperkinesia and learning disability amounted to 8 per cent; in children born in breech presentation it was 14 per cent, while in those born in vertex presentation the corresponding figure was 2 per cent. MBD was more common in boys (16 per cent) than in girls (12 per cent).

Adolescent

Perinatal mortality and morbidity in breech presentation.

The perinatal mortality associated with breech presentation at the Royal Women's Hospital, Melbourne, between 1974 and 1976 was 10.4%, or almost 5 times the overall hospital figure. Nine of 487 infants (1.8%) weighing greater than or equal to 2500 g died in the perinatal period, but 7 were already dead at the onset of labor or had congenital abnormalities incompatible with life. Sixty of 177 infants (33.9%) weighing 1000-2499 g died in the perinatal period, but 28 of these died due to prematurity alone or from complications of intrauterine hypoxia or birth trauma. Although elective cesarean section for breech presentation could not be justified for infants weighing greater than or equal to 2500 g, this procedure may well reduce the perinatal loss of premature infants by reducing the incidence of intrauterine hypoxia and preventing birth trauma.

Apgar Score

[Breech presentation deliveries].

A total of 5,519 consecutive single deliveries at term were analysed for maternal and foetal factors associated with breech presentation (UK). The protocol in this department for breech deliveries which permits vaginal delivery of foetuses estimated to be between 2,400 and 3,800 g in cases where the pelvis was considered to be clinically normal, was also evaluated. Breech presentation was found in 173 cases. In 102 of these circumstances were present which permitted trial of vaginal delivery. Seventy-seven were delivered vaginally. An increased frequency of low Apgar scores (less than 8) after one minute was demonstrated among infants delivered vaginally in the breech presentation on comparison with infants delivered by Caesarean section, whereas low scoring after five minutes occurred with the same frequency. One infant died during delivery. Follow-up of infants delivered in breech presentation (mean period of observation two years) showed developmental disturbances in three of the vaginally delivered infants and in five of those delivered abdominally. Two of the infants delivered abdominally had severe cerebral paresis and psychomotor retardation without evidence of intrauterine or severe neonatal asphyxia. On comparison with the population delivered in cephalic presentation (HST), significantly increased frequencies of primiparity and light-for-dates infants were found in the breech presentations. Low Apgar score after one minute was significantly more frequent in breech presentations while low Apgar scoring after five minutes occurred with the same frequency. The perinatal mortality rates in breech and cephalic presentations were 17.3 and 4.7 per 1,000 respectively. Following correction for lethal malformations, the rates were 5.8 and 3.8 per 1,000, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Apgar Score

[Results of mostly vaginal deliveries of breech presentation].

This report presents results of a retrospective study of infants delivered by the breech, which were according the attitude of this hospital mainly delivered vaginally. This mode of delivery was chosen for primiparae as well as for multiparae and independent of the fetal size measured by ultrasound. Indication for primary caesarean section was seen in only 45 cases out of 568 infants in breech situation. In most of these cases additional indications so as bleedings, placental insufficiency etc, were responsible for the decision of primary caesarean section. Breech presentations are associated to specialties during pregnancy and labour although being more often not related to breech presentation of the fetus as this study shows. Difficulties of spontaneous breech delivered infants were seen rarely. Within the reported cases were 5 of elevated arms, 2 with difficulties in developing the arms and 3 with difficulties in developing the after coming head. Indication for secondary caesarean section were mainly caused by standstill within delivery because of relative disproportion, imminent intrauterine hypoxia and cord prolapse being more often associated to breech presentation. Most important for the possibility of spontaneous breech delivery is the coming deeper of breech during expulsive period. The well known fact of increased number of congenital malformations and anomalies associated to breech presentation were also described in this study. The comparison of the Apgar scores of infants being delivered vaginally or by caesarean section did not show any negative influence of the vaginal mode. This results are independent of different birth weight groups. Therefore there is no evidence to support the recommendation to increase caesarean section rate. Cases of neonatal death--only 13 out of 568 breech infants are discussed casuistically. As a conclusion the authors are confirmed in their conservative attitude and they think the endeavour of spontaneous delivery of breech presentation is justified in all cases unless there are additional indications for caesarean section.

Adolescent

Vaginal birth after cesarean delivery. Trial of labor in women with breech presentation.

Vaginal birth after cesarean delivery in a woman with breech presentation is a controversial issue. In this prospective study, 137 patients had a breech presentation. Of them, 27 (19.7%) met the protocol criteria for attempted vaginal delivery and desired a trial of labor. Thirteen (48%) achieved vaginal delivery, with no increase in fetal or maternal morbidity. Our data suggest that in selected patients, a trial of labor after a cesarean delivery with a breech presentation is a reasonable consideration.

Breech Presentation

[Breech presentation in multiple pregnancy].

A retrospective analysis of the ten-year experience with the delivery of twins in breech presentation was performed in this paper. Out of 17,300 deliveries there were 173 deliveries of twins which accounted for 1%. From that number there were 99 (57.2%) multiple deliveries where one or both of the twins were in breech presentation. Deliveries in this group were more frequently terminated surgically (31.8%) than in the whole population of deliveries of twins (x2 = 26,182; p less than 0.001). In this group of 99 deliveries, out of 198 twins 117 were born with the body mass less than 2,500 g (59.1%) and 56 (56.6%) pregnancies were terminated prior to 37th week of gestation. Perinatal mortality was greater in the group of twins with breech presentation (12.52:9.8%). Breech presentation put the fetus at risk due to two reasons--multiple pregnancy (high prematurity and newborn with the delay in fetal growth and development) on one hand and complications which may arise during the breech presentation on the other.

Adult

[Cerebral damage following breech presentation].

445 single babies were born from breech presentation at the Obstetric Department of the Medical Faculty in Plzen in the years 1962 to 1966. The perinatal mortality was 71,9%. Intracranial bleeding was the most frequent cause of death. All survived children were examined by the pediatric neurologist and psychologist at the age of 9 to 13 years. 4,24% have suffered from cerebral palsy, 3,0% from epilepsy and 22,8% from minimal brain damage. Having analysed the methods of conducting the deliveries we found out that the best prognosis for survival as well as for psychomotoric development in breech presentation have the babies delivered by elective Caesarean section.

Asphyxia Neonatorum

[The effect of preventive cesarean section in breech presentation on perinatal mortality].

This study is based upon 1229 infants delivered from breech presentations who were investigated for the influence of the prophylactic Caesarean section carried out with primiparae after their 36th week of pregnancy in 1972, on perinatal mortality. The periods under report, i. e., 1966 to 1971 and 1972 to 1975, were compared with one another. The incidence of Caesarean sections carried out in breech presentations increased from 11.6% to 52.2%. With a premature birth rate of 22.1% and 20.9%, respectively, the uncleaned perinatal mortality decreased from 109.2% to 96.5%, whereas the cleaned one dropped from 73.3% to 64.2%. As to mature infants delivered vaginally or by Caesarean section, there was no significant difference in death rates. The worse prognosis for breech presentation infants given birth by pluriparae could be confirmed. The high portion of underweight infants amounting to 78.0% and 82.9%, respectively, in the total number of perinatal deaths illustrates the main problem of the breech presentation births.

Birth Weight