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  • Title: [Results of mostly vaginal deliveries of breech presentation].
    Author: Hofmann D, Carle-Grewe G.
    Journal: Zentralbl Gynakol; 1990; 112(24):1525-40. PubMed ID: 2072979.
    Abstract:
    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.
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