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Outcome of 1040 consecutive breech deliveries: clinical experience of a maternity hospital in Turkey
International Journal of Gynecology & Obstetrics 59 Ž1997. 115]118
Article
Outcome of 1040 consecutive breech deliveries: clinical experience of a maternity hospital in Turkey S. Erkayaa , R.A. Tuncer a,U , ¨I. Kutlar a , N. Onat b , S. Erc¸akmak a a b
Department of Obstetrics, Zubeyde Hanim Maternity Hospital, Altindag, ¨ ˘ Turkey Department of Pediatrics, Zubeyde Hanim Maternity Hospital, Altindag, ¨ ˘ Turkey
Received 26 February 1997; received in revised form 15 August 1997; accepted 18 August 1997
Abstract Objecti®e: To determine the optimal route of delivery in breech presentation. Method: One-thousand and forty singleton breech deliveries among a total of 41 785 deliveries that occurred at Zubeyde Hanim Maternity Hospital ¨ between 1990 and 1994 were analyzed. Result: The breech deliveries accounted for 2.4% of all deliveries. Of the patients, 572 Ž56.3%. were delivered vaginally and 468 Ž43.7%. were delivered by cesarean section. The mean ages of vaginal and cesarean delivery groups were 25.2 and 24.6 years, respectively. Forty-one Ž3.9%. of the fetuses had congenital anomaly. The leading congenital anomalies were meningocele in seven and hydrocephalus in six patients. Mullerian anomalies were encountered in 29 Ž6.1%. patients at cesarean section. Fetal morbidity observed in cesarean deliveries were fracture of the humerus in one and fracture of the femur in one and soft tissue injury in four cases. Fracture of the humerus was observed in two, Erb’s paralysis in four, facial paralysis in one and soft tissue injury in 43 fetuses delivered vaginally. The leading causes of puerperal maternal morbidity were genital tract lacerations in vaginal delivery group and wound infection in cesarean delivery group. The overall perinatal mortality of this series was 54.8r1000 Ž57r1040.. The corrected figures for cesarean delivery and vaginal delivery groups were 8.5r1000 Ž4r467. and 57.9r1000 Ž32r552., respectively. Conclusion: We favor a selective approach for mode of delivery in patients with breech presentation in order to balance the fetal morbidity associated with vaginal delivery and maternal morbidity and cost associated with cesarean delivery. Q 1997 International Federation of Gynecology and Obstetrics Keywords: Breech presentation; Perinatal morbidity; Cesarean delivery
U
Corresponding author. Buklum ¨ ¨ Sokak No: 57r5, Kavaklidere, 06660 Ankara, Turkey. Tel.: q90 312 4689896; fax: q90 312 4190033. 0020-7292r97r$17.00 Q 1997 International Federation of Gynecology and Obstetrics PII S0020-7292Ž97.00197-5
116
S. Erkaya et al. r International Journal of Gynecology & Obstetrics 59 (1997) 115]118
1. Introduction An increased frequency of complications including perinatal morbidity and mortality from difficult delivery, prolapsed cord, placenta previa, fetal and uterine anomalies and operative intervention have been reported in breech deliveries w1]4x. Cesarean delivery of the breech fetus of any gestational age has been recommended to reduce perinatal morbidity and mortality although some studies failed to demonstrate this advantage w5]11x. Furthermore, cesarean delivery has been accused to increase maternal morbidity and mortality as well as the cost above that of vaginal delivery w12,13x. Since the optimal management of breech presentation still remains controversial, 1040 consecutive breech deliveries in a single institution were reviewed with the hope of improving management of such deliveries. 2. Materials and methods One thousand and forty singleton breech deliveries that occurred at Zubeyde Hanim Maternity ¨ Hospital between 1990 and 1994 were analyzed retrospectively. The data for this study were derived from 41.785 deliveries, of which 5589 Ž13.3%. were by cesarean section, during the study period. All the deliveries were performed by one of the specialist staff members. However, the mode of delivery varied according to the attending physician’s preference. The vaginal deliveries were carried out using partial breech extraction with Mauriceau maneuver for after-coming head. Cesarean deliveries were carried out using Pfannenstiel and low segment transverse uterine incision. The term early perinatal mortality refers to all stillbirths and neonatal deaths in the first week of extrauterine life. The Chi-squared test is employed for statistical analysis. 3. Results The breech presentation accounted for 2.4% Ž1.040r41.785. of all deliveries. Of the patients, 531 Ž51.0%. had frank, 230 had complete and 279
had incomplete type of breech presentation. While 572 Ž56.3%. of the patients were delivered vaginally, 468 Ž43.7%. were delivered by cesarean section. Frank, complete and incomplete breech presentations were observed in 249 Ž53.2%., 110 and 109 patients delivered by cesarean section, respectively. Corresponding figures for the vaginal deliveries were 282 Ž49.3%., 120 and 170 patients, respectively. The mean ages of vaginal and cesarean delivery groups were 25.2 and 24.6 years, respectively. The primigravid patients constituted 73.0% of the patients delivered by cesarean section and 28.4% of the patients delivered vaginally. Three-hundred and forty-two Ž67.7%. of the primigravid patients were subjected to cesarean section whereas the others were delivered vaginally. Preterm deliveries constituted 31.2% Ž179r572. of vaginal deliveries and 14.9% Ž70r468. of cesarean deliveries. The mean birth weights in vaginal and cesarean delivery groups were 2940.6 g and 3067.3 g, respectively. The maternal age, parity, gestational Table 1 Maternal age, parity, gestational age, and birth weight distribution CrS
Vaginal
Total
53 250 124 36 5
38 254 198 62 20
91 504 322 98 25
342 84 29 13
163 206 141 62
505 290 170 85
Maternal age - 18 19]24 25]30 31]35 ) 35 Parity 0 1 2 G3 Gestational age Žweeks. 28]33 34]36 37]41 ) 41 Birth weight Žg. 1000]1500 1500]2500 2500]4000 ) 4000
9 61 373 25
77 102 349 42
86 163 722 67
2 40 392 34
36 96 401 39
38 136 793 73
Total
468
572
1040
S. Erkaya et al. r International Journal of Gynecology & Obstetrics 59 (1997) 115]118
age and birth weight distribution is displayed in Table 1. Fetal morbidity observed in cesarean deliveries were fracture of the humerus in one and fracture of the femur in one and soft tissue injury in four cases. Fracture of the humerus was observed in two, Erb’s paralysis in four, facial paralysis in one and soft tissue injury Žecchymosis. in 23 neonates delivered vaginally. Forty-one Ž3.9%. of the fetuses had congenital anomaly. The fetal anomalies were observed in 32 patients delivered vaginally whereas nine patients delivered by cesarean section had fetal anomalies ŽTable 2.. The leading congenital anomalies were meningocele in seven and hydrocephalus in six patients. Thirty-seven of the patients were diagnosed to have fetal death in utero at admission to the hospital. The remaining 20 perinatal losses occurred during labor or delivery. Thus, the overall perinatal mortality of this series was 54.8r1000 Ž57r1040.. When the losses due to fetal anomaly Ž n s 21. were excluded, corrected perinatal mortality was found to be 48.2r1000 Ž36r1019.. The figures for cesarean delivery and vaginal delivery groups were 8.5r1000 Ž4r467. and 57.9r1000 Ž32r552., respectively Ž P- 0.01.. However, with regard to the patients with fetal heart tones and without fetal anomaly; corresponding figures for cesarean and vaginal delivery groups were 6.4r1000 Ž3r466. and 31.7r1000 Ž17r537., respectively Ž P- 0.01.. Table 2 Fetal anomalies Fetal anomaly
CrS
Vaginal
Total
Hydrocephalus Anencephaly Meningocele Microcephaly Hip dislocation Pes equinovarus Hipospadias Cleft palate Down syndrome Multiple congenital structural defect
2 } 1 } } 1 1 1 }
4 5 6 1 4 2 1 } 1
6 5 7 1 4 2 2 1 1
3
8
11
Total
9
32
41
117
Mullerian anomalies were encountered in 29 Ž6.1%. patients at cesarean section. Of the patients with uterine anomalies, 12 had bicornuate uterus, 11 had septate uterus, four had arcuate uterus and two patients were didelphic. Only one patient was found to have bicornuate uterus following vaginal delivery. In terms of puerperal morbidity after vaginal delivery, 57 patients had perineal and vaginal lacerations, three had cervical lacerations, 11 had febrile morbidity, four had urinary infection and one had vesicourethrovaginal fistula which was successfully repaired. Following cesarean, 16 had wound infection, eight had urinary infection and two had post-partum atonia one of which needed hysterectomy. In three of the repeat cesarean deliveries, uterine dehiscence was observed at surgery. The mean hospitalization time for vaginal and cesarean deliveries were 3.2 days Žrange: 2]9. and 5.8 days Žrange: 3]16., respectively. Vaginal and cesarean delivery costs including mean hospitalization days were $ 170 and $ 270, respectively. 4. Discussion Approximately 3% of all deliveries present as breech at term w3,10,14x. Present frequency of 2.4% in this series consisting of mostly term and near term patients may be evaluated to correlate well with the literature. An increased frequency of fetal and Mullerian anomalies have been reported in breech presentation w14]16x. An incidence of 3.9% as major fetal anomalies in this series confirms previous reports. Approximately 6% of patients were diagnosed to have Mullerian anomalies which is a finding showing importance of reproductive anomalies in the etiology of breech presentation. Much of the controversy arises from the optimal mode of delivery in breech presentation w3,4,6]10x. Routine elective cesarean delivery of the breech fetus has been recommended to decrease perinatal morbidity and mortality in 1950s w5x. From that time, the acceptance of cesarean delivery has grown steadily and the abdominal delivery of a breech presenting fetus occurs in
118
S. Erkaya et al. r International Journal of Gynecology & Obstetrics 59 (1997) 115]118
over 85% of cases in USA w11,17x. Nevertheless, several groups report no difference in morbidity and mortality among those delivered vaginally vs. those delivered abdominally particularly in selected cases w4,11x. Increased perinatal survival after cesarean delivery in this series support the modern trend. However, even with liberal use of cesarean delivery there still remained increased risk for the infant delivered as a breech since maneuvers of extracting a breech by cesarean delivery are similar to those associated with vaginal delivery w14,18x. Observation of two cases with bone fracture in this series after cesarean delivery seems to approve the thought that cesarean delivery alone can not assure a better outcome. To overcome this problem, Calvert et al. in 1980 urged more liberal use of large uterine incisions for breeches w19x. Employment of this approach will further decrease fetal morbidity in cesarean delivery. Cesarean delivery seems to increase maternal morbidity and hospitalization time in this series as well as in the literature w4,13,17,18x. The majority of complications following vaginal delivery were lacerations of the lower genital tract. They are usually of minor importance and duration and they usually do not lengthen the duration of hospitalization as seen in this series of patients. In conclusion, since most of the patients in the vaginal delivery group seem to experience an uneventful delivery, we favor a selective approach for mode of delivery in patients with breech presentation in order to balance the fetal morbidity associated with vaginal delivery and maternal morbidity and cost associated with cesarean delivery. References w1x Brenner WE, Bruce RD, Hendrichs CH. The characteristics and perils of breech presentation. Am J Obstet Gynecol 1974;118:700. w2x Gimovsky ML, Paul RH. Singleton breech presentation in labor. Am J Obstet Gynecol 1982;143:733. w3x Schiff E, Friedman SA, Mashiach S, Hart O, Barkai G,
w4x
w5x
w6x
w7x
w8x
w9x
w10x
w11x
w12x
w13x
w14x
w15x w16x w17x w18x w19x
Sibai BM. Maternal and neonatal outcome of 846 term singleton breech deliveries: Seven-year experience at a single center. Am J Obstet Gynecol 1996;175:18]23. Spelliscy D, Morton SC, Fiske M, Kahn K. A met-analysis of infant outcomes after breech delivery. Obstet Gynecol 1995;85:1047]1054. Wright RC. Reduction of perinatal mortality and morbidity in breech delivery through routine use of cesarean section. Obstet Gynecol 1959;14:758. Danielian PJ, Wang J, Hall MH. Long term outcome by method of delivery of fetuses in breech presentation at term: population based follow-up. Br Med J 1996;312:14513. Kiely JL. Mode of delivery and neonatal death in 17 587 infants presenting by the breech. Br J Obstet Gynaecol 1991;98:898]904. Hannah M, Hannah W. Cesarean section or vaginal birth for breech presentation at term. Br Med J 1996;312:1433. Eller DP, VanDorsten JP. Route of delivery for the breech presentation: A conundrum. Am J Obstet Gynecol 1995;173:393]398. Beeston-Thorpe JG, Banfield PJ, Saunders NJ StG. Outcome of breech delivery at term. Br Med J 1992;305:746]747. Cheng M, Hannah M. Breech delivery at term: A critical review of the literature. Obstet Gynecol 1993;82: 605]618. Green JE, McLean F, Smith LP, Usher R. Has an increased cesarean section rate for term breech delivery reduced the incidence of birth asphyxia, trauma and death? Am J Obstet Gynecol 1982;142:643. Flamm BL, Newman LA, Thomas SJ, Fallon D, Yoshida MM. Vaginal birth after cesarean delivery: results of a 5-year multicenter collaborative study. Obstet Gynecol 1990;76:750. Cunningham FG, MacDonald PC, Leveno KJ, Gant NF, Gilstrap III LC. Dystocia due to abnormalities in presentation, position, or development of the fetus. In: Cunningham FG, MacDonald PC, Leveno KJ, Gant NF, Gilstrap III LC, editors. Williams Obstetrics. 19th ed. Prentice-Hall, 1993:493. Hytten FE. Breech presentation: Is it a bad omen? Br J Obstet Gynaecol 1982;89:879. Susuki S, Yamamuro T. Fetal movement and fetal presentation. Early Hum Dev 1985;11:285. Cibils LA. Management of a full-term fetus presenting by the breech. Obstet Gynecol Surv 1995;50:762. Weiner CP. Vaginal breech delivery in the 1990s. Clin Obstet Gynecol 1992;35:559. Calvert JP. Intrinsic hazard of breech presentation. Br Med J 1980;281:1319.
Article
Outcome of 1040 consecutive breech deliveries: clinical experience of a maternity hospital in Turkey S. Erkayaa , R.A. Tuncer a,U , ¨I. Kutlar a , N. Onat b , S. Erc¸akmak a a b
Department of Obstetrics, Zubeyde Hanim Maternity Hospital, Altindag, ¨ ˘ Turkey Department of Pediatrics, Zubeyde Hanim Maternity Hospital, Altindag, ¨ ˘ Turkey
Received 26 February 1997; received in revised form 15 August 1997; accepted 18 August 1997
Abstract Objecti®e: To determine the optimal route of delivery in breech presentation. Method: One-thousand and forty singleton breech deliveries among a total of 41 785 deliveries that occurred at Zubeyde Hanim Maternity Hospital ¨ between 1990 and 1994 were analyzed. Result: The breech deliveries accounted for 2.4% of all deliveries. Of the patients, 572 Ž56.3%. were delivered vaginally and 468 Ž43.7%. were delivered by cesarean section. The mean ages of vaginal and cesarean delivery groups were 25.2 and 24.6 years, respectively. Forty-one Ž3.9%. of the fetuses had congenital anomaly. The leading congenital anomalies were meningocele in seven and hydrocephalus in six patients. Mullerian anomalies were encountered in 29 Ž6.1%. patients at cesarean section. Fetal morbidity observed in cesarean deliveries were fracture of the humerus in one and fracture of the femur in one and soft tissue injury in four cases. Fracture of the humerus was observed in two, Erb’s paralysis in four, facial paralysis in one and soft tissue injury in 43 fetuses delivered vaginally. The leading causes of puerperal maternal morbidity were genital tract lacerations in vaginal delivery group and wound infection in cesarean delivery group. The overall perinatal mortality of this series was 54.8r1000 Ž57r1040.. The corrected figures for cesarean delivery and vaginal delivery groups were 8.5r1000 Ž4r467. and 57.9r1000 Ž32r552., respectively. Conclusion: We favor a selective approach for mode of delivery in patients with breech presentation in order to balance the fetal morbidity associated with vaginal delivery and maternal morbidity and cost associated with cesarean delivery. Q 1997 International Federation of Gynecology and Obstetrics Keywords: Breech presentation; Perinatal morbidity; Cesarean delivery
U
Corresponding author. Buklum ¨ ¨ Sokak No: 57r5, Kavaklidere, 06660 Ankara, Turkey. Tel.: q90 312 4689896; fax: q90 312 4190033. 0020-7292r97r$17.00 Q 1997 International Federation of Gynecology and Obstetrics PII S0020-7292Ž97.00197-5
116
S. Erkaya et al. r International Journal of Gynecology & Obstetrics 59 (1997) 115]118
1. Introduction An increased frequency of complications including perinatal morbidity and mortality from difficult delivery, prolapsed cord, placenta previa, fetal and uterine anomalies and operative intervention have been reported in breech deliveries w1]4x. Cesarean delivery of the breech fetus of any gestational age has been recommended to reduce perinatal morbidity and mortality although some studies failed to demonstrate this advantage w5]11x. Furthermore, cesarean delivery has been accused to increase maternal morbidity and mortality as well as the cost above that of vaginal delivery w12,13x. Since the optimal management of breech presentation still remains controversial, 1040 consecutive breech deliveries in a single institution were reviewed with the hope of improving management of such deliveries. 2. Materials and methods One thousand and forty singleton breech deliveries that occurred at Zubeyde Hanim Maternity ¨ Hospital between 1990 and 1994 were analyzed retrospectively. The data for this study were derived from 41.785 deliveries, of which 5589 Ž13.3%. were by cesarean section, during the study period. All the deliveries were performed by one of the specialist staff members. However, the mode of delivery varied according to the attending physician’s preference. The vaginal deliveries were carried out using partial breech extraction with Mauriceau maneuver for after-coming head. Cesarean deliveries were carried out using Pfannenstiel and low segment transverse uterine incision. The term early perinatal mortality refers to all stillbirths and neonatal deaths in the first week of extrauterine life. The Chi-squared test is employed for statistical analysis. 3. Results The breech presentation accounted for 2.4% Ž1.040r41.785. of all deliveries. Of the patients, 531 Ž51.0%. had frank, 230 had complete and 279
had incomplete type of breech presentation. While 572 Ž56.3%. of the patients were delivered vaginally, 468 Ž43.7%. were delivered by cesarean section. Frank, complete and incomplete breech presentations were observed in 249 Ž53.2%., 110 and 109 patients delivered by cesarean section, respectively. Corresponding figures for the vaginal deliveries were 282 Ž49.3%., 120 and 170 patients, respectively. The mean ages of vaginal and cesarean delivery groups were 25.2 and 24.6 years, respectively. The primigravid patients constituted 73.0% of the patients delivered by cesarean section and 28.4% of the patients delivered vaginally. Three-hundred and forty-two Ž67.7%. of the primigravid patients were subjected to cesarean section whereas the others were delivered vaginally. Preterm deliveries constituted 31.2% Ž179r572. of vaginal deliveries and 14.9% Ž70r468. of cesarean deliveries. The mean birth weights in vaginal and cesarean delivery groups were 2940.6 g and 3067.3 g, respectively. The maternal age, parity, gestational Table 1 Maternal age, parity, gestational age, and birth weight distribution CrS
Vaginal
Total
53 250 124 36 5
38 254 198 62 20
91 504 322 98 25
342 84 29 13
163 206 141 62
505 290 170 85
Maternal age - 18 19]24 25]30 31]35 ) 35 Parity 0 1 2 G3 Gestational age Žweeks. 28]33 34]36 37]41 ) 41 Birth weight Žg. 1000]1500 1500]2500 2500]4000 ) 4000
9 61 373 25
77 102 349 42
86 163 722 67
2 40 392 34
36 96 401 39
38 136 793 73
Total
468
572
1040
S. Erkaya et al. r International Journal of Gynecology & Obstetrics 59 (1997) 115]118
age and birth weight distribution is displayed in Table 1. Fetal morbidity observed in cesarean deliveries were fracture of the humerus in one and fracture of the femur in one and soft tissue injury in four cases. Fracture of the humerus was observed in two, Erb’s paralysis in four, facial paralysis in one and soft tissue injury Žecchymosis. in 23 neonates delivered vaginally. Forty-one Ž3.9%. of the fetuses had congenital anomaly. The fetal anomalies were observed in 32 patients delivered vaginally whereas nine patients delivered by cesarean section had fetal anomalies ŽTable 2.. The leading congenital anomalies were meningocele in seven and hydrocephalus in six patients. Thirty-seven of the patients were diagnosed to have fetal death in utero at admission to the hospital. The remaining 20 perinatal losses occurred during labor or delivery. Thus, the overall perinatal mortality of this series was 54.8r1000 Ž57r1040.. When the losses due to fetal anomaly Ž n s 21. were excluded, corrected perinatal mortality was found to be 48.2r1000 Ž36r1019.. The figures for cesarean delivery and vaginal delivery groups were 8.5r1000 Ž4r467. and 57.9r1000 Ž32r552., respectively Ž P- 0.01.. However, with regard to the patients with fetal heart tones and without fetal anomaly; corresponding figures for cesarean and vaginal delivery groups were 6.4r1000 Ž3r466. and 31.7r1000 Ž17r537., respectively Ž P- 0.01.. Table 2 Fetal anomalies Fetal anomaly
CrS
Vaginal
Total
Hydrocephalus Anencephaly Meningocele Microcephaly Hip dislocation Pes equinovarus Hipospadias Cleft palate Down syndrome Multiple congenital structural defect
2 } 1 } } 1 1 1 }
4 5 6 1 4 2 1 } 1
6 5 7 1 4 2 2 1 1
3
8
11
Total
9
32
41
117
Mullerian anomalies were encountered in 29 Ž6.1%. patients at cesarean section. Of the patients with uterine anomalies, 12 had bicornuate uterus, 11 had septate uterus, four had arcuate uterus and two patients were didelphic. Only one patient was found to have bicornuate uterus following vaginal delivery. In terms of puerperal morbidity after vaginal delivery, 57 patients had perineal and vaginal lacerations, three had cervical lacerations, 11 had febrile morbidity, four had urinary infection and one had vesicourethrovaginal fistula which was successfully repaired. Following cesarean, 16 had wound infection, eight had urinary infection and two had post-partum atonia one of which needed hysterectomy. In three of the repeat cesarean deliveries, uterine dehiscence was observed at surgery. The mean hospitalization time for vaginal and cesarean deliveries were 3.2 days Žrange: 2]9. and 5.8 days Žrange: 3]16., respectively. Vaginal and cesarean delivery costs including mean hospitalization days were $ 170 and $ 270, respectively. 4. Discussion Approximately 3% of all deliveries present as breech at term w3,10,14x. Present frequency of 2.4% in this series consisting of mostly term and near term patients may be evaluated to correlate well with the literature. An increased frequency of fetal and Mullerian anomalies have been reported in breech presentation w14]16x. An incidence of 3.9% as major fetal anomalies in this series confirms previous reports. Approximately 6% of patients were diagnosed to have Mullerian anomalies which is a finding showing importance of reproductive anomalies in the etiology of breech presentation. Much of the controversy arises from the optimal mode of delivery in breech presentation w3,4,6]10x. Routine elective cesarean delivery of the breech fetus has been recommended to decrease perinatal morbidity and mortality in 1950s w5x. From that time, the acceptance of cesarean delivery has grown steadily and the abdominal delivery of a breech presenting fetus occurs in
118
S. Erkaya et al. r International Journal of Gynecology & Obstetrics 59 (1997) 115]118
over 85% of cases in USA w11,17x. Nevertheless, several groups report no difference in morbidity and mortality among those delivered vaginally vs. those delivered abdominally particularly in selected cases w4,11x. Increased perinatal survival after cesarean delivery in this series support the modern trend. However, even with liberal use of cesarean delivery there still remained increased risk for the infant delivered as a breech since maneuvers of extracting a breech by cesarean delivery are similar to those associated with vaginal delivery w14,18x. Observation of two cases with bone fracture in this series after cesarean delivery seems to approve the thought that cesarean delivery alone can not assure a better outcome. To overcome this problem, Calvert et al. in 1980 urged more liberal use of large uterine incisions for breeches w19x. Employment of this approach will further decrease fetal morbidity in cesarean delivery. Cesarean delivery seems to increase maternal morbidity and hospitalization time in this series as well as in the literature w4,13,17,18x. The majority of complications following vaginal delivery were lacerations of the lower genital tract. They are usually of minor importance and duration and they usually do not lengthen the duration of hospitalization as seen in this series of patients. In conclusion, since most of the patients in the vaginal delivery group seem to experience an uneventful delivery, we favor a selective approach for mode of delivery in patients with breech presentation in order to balance the fetal morbidity associated with vaginal delivery and maternal morbidity and cost associated with cesarean delivery. References w1x Brenner WE, Bruce RD, Hendrichs CH. The characteristics and perils of breech presentation. Am J Obstet Gynecol 1974;118:700. w2x Gimovsky ML, Paul RH. Singleton breech presentation in labor. Am J Obstet Gynecol 1982;143:733. w3x Schiff E, Friedman SA, Mashiach S, Hart O, Barkai G,
w4x
w5x
w6x
w7x
w8x
w9x
w10x
w11x
w12x
w13x
w14x
w15x w16x w17x w18x w19x
Sibai BM. Maternal and neonatal outcome of 846 term singleton breech deliveries: Seven-year experience at a single center. Am J Obstet Gynecol 1996;175:18]23. Spelliscy D, Morton SC, Fiske M, Kahn K. A met-analysis of infant outcomes after breech delivery. Obstet Gynecol 1995;85:1047]1054. Wright RC. Reduction of perinatal mortality and morbidity in breech delivery through routine use of cesarean section. Obstet Gynecol 1959;14:758. Danielian PJ, Wang J, Hall MH. Long term outcome by method of delivery of fetuses in breech presentation at term: population based follow-up. Br Med J 1996;312:14513. Kiely JL. Mode of delivery and neonatal death in 17 587 infants presenting by the breech. Br J Obstet Gynaecol 1991;98:898]904. Hannah M, Hannah W. Cesarean section or vaginal birth for breech presentation at term. Br Med J 1996;312:1433. Eller DP, VanDorsten JP. Route of delivery for the breech presentation: A conundrum. Am J Obstet Gynecol 1995;173:393]398. Beeston-Thorpe JG, Banfield PJ, Saunders NJ StG. Outcome of breech delivery at term. Br Med J 1992;305:746]747. Cheng M, Hannah M. Breech delivery at term: A critical review of the literature. Obstet Gynecol 1993;82: 605]618. Green JE, McLean F, Smith LP, Usher R. Has an increased cesarean section rate for term breech delivery reduced the incidence of birth asphyxia, trauma and death? Am J Obstet Gynecol 1982;142:643. Flamm BL, Newman LA, Thomas SJ, Fallon D, Yoshida MM. Vaginal birth after cesarean delivery: results of a 5-year multicenter collaborative study. Obstet Gynecol 1990;76:750. Cunningham FG, MacDonald PC, Leveno KJ, Gant NF, Gilstrap III LC. Dystocia due to abnormalities in presentation, position, or development of the fetus. In: Cunningham FG, MacDonald PC, Leveno KJ, Gant NF, Gilstrap III LC, editors. Williams Obstetrics. 19th ed. Prentice-Hall, 1993:493. Hytten FE. Breech presentation: Is it a bad omen? Br J Obstet Gynaecol 1982;89:879. Susuki S, Yamamuro T. Fetal movement and fetal presentation. Early Hum Dev 1985;11:285. Cibils LA. Management of a full-term fetus presenting by the breech. Obstet Gynecol Surv 1995;50:762. Weiner CP. Vaginal breech delivery in the 1990s. Clin Obstet Gynecol 1992;35:559. Calvert JP. Intrinsic hazard of breech presentation. Br Med J 1980;281:1319.