SUMMARY: ACOG has released guidance that addresses the trend in the United States to deliver term singleton fetuses in breech presentation. If the presentation of a breech presentation is confirmed at term, a . the American College of Obstetricians and Gynecologists (ACOG) and the. The incidence of breech presentation decreases from about 20% at 28 weeks of asphyxia or trauma.1,2 Caesarean section for breech presentation has been.
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Given the results of this exceptionally large and well-controlled clinical trial, the American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice in recommended that planned vaginal delivery of a term singleton breech was no longer appropriate. A test in which sound waves are used to examine internal structures.
A condition in which the membranes that hold the amniotic fluid rupture before labor. Tissue that provides nourishment to and takes waste away from the fetus. If a vaginal breech delivery is planned, a detailed informed consent should be documented-including risks that perinatal or neonatal mortality or short-term serious neonatal morbidity may be higher than if a cesarean delivery is planned.
American College of Obstetricians and Gynecologists. Term Breech Trial Collaborative Group. Obstetrician—gynecologists and other obstetric care providers should offer external cephalic version as an alternative to planned cesarean for a woman who has a term singleton breech fetus, desires a planned vaginal delivery of a vertex-presenting fetus, and has no contraindications 9.
The benefits of planned cesarean delivery remained for all subgroups identified by the baseline variables eg, older and younger women, nulliparous and multiparous women, frank and complete type of breech presentation. Planned caesarean section decreases the risk of adverse perinatal outcome acov to presentatkon labour and delivery complications in the Term Breech Trial. Long-term benefits of planned cesarean delivery for these infants and women are less clear 14 The American College of Obstetricians and Gynecologists has neither solicited nor accepted any commercial involvement in the development of the content of this published product.
Inresearchers conducted a large, international multicenter randomized clinical trial comparing a policy of planned cesarean delivery with planned vaginal delivery Term Breech Trial 3. External cephalic version should be attempted only in settings in which cesarean delivery services are readily available 9.
The frequency of adverse events was not significantly brsech between groups receiving and not receiving regional anesthesia for external cephalic version In the last weeks of pregnancy, fetuses usually move so that their heads are positioned to come out of the vagina first during birth. As acot fetus grows bigger, there is less room for him or her to move.
The studies presentatiom in this meta-analysis did not employ analgesia for the external cephalic version.
This information should not be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care. At 3 months postpartum, the risk of urinary incontinence was lower for women in the planned cesarean delivery group; however, there was no difference at 2 years. Between and35, term presenyation were delivered.
Women’s Health Care Physicians
Cesarean delivery presentatiom be the preferred mode of delivery for most physicians because of the diminishing expertise in vaginal breech delivery.
Published online on July 25, There are several explanations for this seemingly contradictory finding. External cephalic version ECV is an attempt to turn the fetus so that he or she is head down.
The information does not dictate an exclusive course of treatment or procedure to be followed and should not be construed as excluding other acceptable methods of practice.
External cephalic version should be attempted only in settings in which cesarean delivery services are readily available.
If Your Baby Is Breech – ACOG
If the fetus is breech and you presentatino between 36 weeks and 38 weeks of pregnancy, your health care professional may suggest ECV. Neither ACOG nor its officers, directors, members, employees, or agents will be liable for any loss, damage, or claim with respect to any liabilities, including direct, special, indirect, or consequential damages, incurred in connection with this publication or reliance on the information presented.
The risks of planned vaginal breech delivery versus planned caesarean section for term breech birth: It is not intended to substitute for the independent professional judgment of the treating clinician. ECV usually is done near a delivery room. The decision regarding the mode of delivery should consider patient wishes and the experience of the health care provider.
Current evidence demonstrates short-term benefits in neonatal and maternal morbidity and mortality from planned cesarean delivery of the term fetus with a breech presentation. Of interest, a decrease in mortality also was seen in the emergency cesarean delivery group and the vaginal delivery group, a finding that the authors attribute to better selection of candidates for vaginal breech delivery.
Additional updates have been made to reflect current practice regarding vaginal breech delivery. If you have further questions, contact presentatioh obstetrician—gynecologist. A cesarean delivery is major surgery. Another problem that can happen during a vaginal breech birth is a prolapsed umbilical cord.