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Management of breech delivery
347
ABSTRACTS
Crosse, Mary V.:
Management
of the Frank-Breech
Presentation,
Brit.
M.
J. 2:
113, 1939. In a series of 100 eases the child mortality rate was considerably reduced by using simple methods with no risk to the mother. In the first place, all unnecessary interference was eliminated; and, second, a special effort was made to provide a skilled and sufficient staff of attendants for each breech delivery. The management of the delivery is kept as simple as possible; there is no interference except fundal and suprapubic pressure, unless definite indications arise. A leg is pulled down only when there is definite delay during the secontl stage, as the complete breech is a better dilator than the half-breech. In no case was it found necessary to bring down a leg during the first stage of labor. Traction is not used, as this extends the arms and head. Hot towels are not employed, as they obstruct progress and make handling of the infant difficult. In no case has the child suffered from this omission. Forceps are used only when there is difficulty with the aftercoming head. They are, however, always boiled and ready for use in emergency. Episiotomy has been performed in most of the later cases of the series, especially in primiparas, as it reduces pressure on the infant’s head and also eliminates risk of a third-degree tear. It is done while the breech is distending the vulva. The risk of stillbirths in this series was 4 per cent and the risk of neonatal death, 5 per cent. J. P. GREENHILL.
Goethals,
Thomas R.:
Management
of Breech Delivery,
Surg.
Gynec.
Obst.
70:
620, 1940. The occurrence of breech presentation as a problem in the management of labor at term may be handled in one of three ways. The obstetrician may convert the breech to a vertex by the maneuver of external version; he may deliver the infant as a breech through the pelvis; or he may elect to perform eesarean section. From a study of 2,035 pelvic breech deliveries and 58 abdominal cesarean sections in the Boston Lying-in Hospital from 1988 to 1937 inclusive, the following conclusions have been drawn. 1. About 7 per cent of primigravidas with breech presentations at term should be delivered by section. 2. Roentgenographic mensuration of the fetal head in utero has a definit,e if limited value in helping to diagnose fetopelvic disproportion. The ideal method of making a comparison of the fetopelvic relationship in breech presentation has not yet been determined. 3. The statistics and experience derived in this study indicate that, if delivery through the pelvis is selected as the method of choice, the second stage of labor should be terminated by breech extraction under full surgical anesthesia before the birth of the umbilicus has occurred. WILLIAM
The Radiological Diagnosis Stampfel and Tscherne: Fetus, Ztschr. f. Geburtsh. u. GynIk. 119: 31, 1939. The authors set out to determine the skeleton by the time of delivery of usually employed primary and secondary the infant is born previous to nine days of the calculated date of confinement. of development of the human skeleton, the lack of uniformity in these. The experience of the authors with males and 45 females, leads them to
C. HENSKE.
of Postmaturity
in the
normal state of development of the human the term infant, i. e., just which of the centers of ossification are present when after, but not before nine days in advance They show two previously reported charts refer to several others, and point out x-rays conclude
of 90 term newborn that a term infant
infants, 45 will always
ABSTRACTS
Crosse, Mary V.:
Management
of the Frank-Breech
Presentation,
Brit.
M.
J. 2:
113, 1939. In a series of 100 eases the child mortality rate was considerably reduced by using simple methods with no risk to the mother. In the first place, all unnecessary interference was eliminated; and, second, a special effort was made to provide a skilled and sufficient staff of attendants for each breech delivery. The management of the delivery is kept as simple as possible; there is no interference except fundal and suprapubic pressure, unless definite indications arise. A leg is pulled down only when there is definite delay during the secontl stage, as the complete breech is a better dilator than the half-breech. In no case was it found necessary to bring down a leg during the first stage of labor. Traction is not used, as this extends the arms and head. Hot towels are not employed, as they obstruct progress and make handling of the infant difficult. In no case has the child suffered from this omission. Forceps are used only when there is difficulty with the aftercoming head. They are, however, always boiled and ready for use in emergency. Episiotomy has been performed in most of the later cases of the series, especially in primiparas, as it reduces pressure on the infant’s head and also eliminates risk of a third-degree tear. It is done while the breech is distending the vulva. The risk of stillbirths in this series was 4 per cent and the risk of neonatal death, 5 per cent. J. P. GREENHILL.
Goethals,
Thomas R.:
Management
of Breech Delivery,
Surg.
Gynec.
Obst.
70:
620, 1940. The occurrence of breech presentation as a problem in the management of labor at term may be handled in one of three ways. The obstetrician may convert the breech to a vertex by the maneuver of external version; he may deliver the infant as a breech through the pelvis; or he may elect to perform eesarean section. From a study of 2,035 pelvic breech deliveries and 58 abdominal cesarean sections in the Boston Lying-in Hospital from 1988 to 1937 inclusive, the following conclusions have been drawn. 1. About 7 per cent of primigravidas with breech presentations at term should be delivered by section. 2. Roentgenographic mensuration of the fetal head in utero has a definit,e if limited value in helping to diagnose fetopelvic disproportion. The ideal method of making a comparison of the fetopelvic relationship in breech presentation has not yet been determined. 3. The statistics and experience derived in this study indicate that, if delivery through the pelvis is selected as the method of choice, the second stage of labor should be terminated by breech extraction under full surgical anesthesia before the birth of the umbilicus has occurred. WILLIAM
The Radiological Diagnosis Stampfel and Tscherne: Fetus, Ztschr. f. Geburtsh. u. GynIk. 119: 31, 1939. The authors set out to determine the skeleton by the time of delivery of usually employed primary and secondary the infant is born previous to nine days of the calculated date of confinement. of development of the human skeleton, the lack of uniformity in these. The experience of the authors with males and 45 females, leads them to
C. HENSKE.
of Postmaturity
in the
normal state of development of the human the term infant, i. e., just which of the centers of ossification are present when after, but not before nine days in advance They show two previously reported charts refer to several others, and point out x-rays conclude
of 90 term newborn that a term infant
infants, 45 will always