Citation Information :
Tanacan A, Cagan M, Beksac MS. Changing Trends in the Delivery of Breech Presentation throughout the Last Four Decades. J South Asian Feder Obs Gynae 2019; 11 (3):161-163.
Background: To demonstrate the changing trends in the delivery of breech presentations throughout the last four decades.
Materials and methods: We retrospectively evaluated the birth data in the last four consecutive decades (1980s, 1990s, 2000s, and 2010s) for breech deliveries. A total of 25,513 deliveries between January 1980 and December 2017 were evaluated, with 371, 269, 292, and 275 breech deliveries in the 1980s, 1990s, 2000s, and 2010s groups, respectively.
Results: The incidences of breech presentation for the 1980s, 1990s, 2000s, and 2010s groups were 4.3%, 4.8%, 5.6%, and 4.6%, respectively, and the mean gestational weeks at birth were 37.84 ± 3.23, 36.90 ± 3.22, 36.15 ± 3.22, and 36.35 ± 2.77, respectively. The average gestational week at birth had statistically significantly decreased over the decades (p < 0.001). However, the appearance, pulse, grimace, activity, respiration (APGAR) scores gradually increased (p < 0.001). The cesarean section (CS) rates were 67.6% (251/371), 90.3% (243/269), 96.6% (282/292), and 99.3% (273/275) for the 1980s, 1990s, 2000s, and 2010s groups, respectively, which were statistically significantly different (p < 0.001). The CS rate had gradually increased over the decades.
Conclusion: Cesarean section rates in fetuses with breech presentation have gradually increased over the decades. Choosing vaginal delivery for selected breech presentations, providing proper education to obstetricians regarding breech delivery, regulating medicolegal issues, and encouraging physicians to perform more vaginal deliveries for breech presentation should be the key points in decreasing CS rates associated with breech presentation.
Hickok DE, Gordon DC, et al. The frequency of breech presentation by gestational age at birth: a large population-based study. Am J Obstet Gynecol 1992;166:851–852. DOI: 10.1016/0002-9378(92)91347-D.
Rayl J, Gibson PJ, et al. A population-based case-control study of risk factors for breech presentation. Am J Obstet Gynecol 1996;174:28–32. DOI: 10.1016/S0002-9378(96)70368-X.
Westgren M, Edvall H, et al. Spontaneous cephalic version of breech presentation in the last trimester. Br J Obstet Gynaecol 1985;92:19–22. DOI: 10.1111/j.1471-0528.1985.tb01043.x.
Hofmeyr GJ, Kulier R, et al. External cephalic version for breech presentation at term. Cochrane Database Syst Rev 2015 Apr; 2015(4):Cd000083. DOI: 10.1002/14651858.CD000083.pub3.
Menticoglou SM. Why vaginal breech delivery should still be offered. J Obstet Gynaecol Canada 2006;28:380–385; discussion 386–389. DOI: 10.1016/S1701-2163(16)32155-7.
Hodnett ED, Chalmers B, et al. Outcomes at 3 months after planned cesarean vs planned vaginal delivery for breech presentation at term: the international randomized Term Breech Trial. JAMA 2002;287: 1822–1831. DOI: 10.1001/jama.287.14.1822.
Cheng M, Hannah M. Breech delivery at term: a critical review of the literature. Obstet Gynecol 1993;82:605–618. DOI: 10.1097/00006250-199310010-00026.
Gifford DS, Morton SC, et al. A meta-analysis of infant outcomes after breech delivery. Obstet Gynecol 1995;85:1047–1054. DOI: 10.1016/0029-7844(95)00053-T.
Organization WH. Perinatal mortality: a listing of available information; 1996.
St NS. Controversies: the mature breech should be delivered by elective cesarean section. J Perinat Med 1996;24:545–551. DOI: 10.1515/jpme.1996.24.6.545.
Hannah ME, Hannah WJ, et al. Planned caesarean section vs planned vaginal birth for breech presentation at term: a randomised multicentre trial. Lancet 2000;356:1375–1383. DOI: 10.1016/S0140-6736(00)02840-3.
Louwen F, Leuchter L, et al. Breech presentation-more than just caesarean vs spontaneous birth. Z Geburtshilfe Neonatologie 2012;216:191–194. DOI: 10.1055/s-0032-1309052.
Goffinet F, Carayol M, et al. Is planned vaginal delivery for breech presentation at term still an option? Results of an observational prospective survey in France and Belgium. Am J Obstet Gynecol 2006;194:1002–1011. DOI: 10.1016/j.ajog.2005.10.817.
Håheim LL, Albrechtsen S, et al. Breech birth at term: vaginal delivery or elective cesarean section? A systematic review of the literature by a Norwegian review team. Acta Obstet Gynecol Scand 2004;83:126–130. DOI: 10.1111/j.0001-6349.2004.00349.x.
Hellsten C, Lindqvist PG, et al. Vaginal breech delivery: is it still an option? Eur J Obstet Gynecol Reprod Biol 2003;111:122–128. DOI: 10.1016/S0301-2115(03)00189-1.
Toivonen E, Palomäki O, et al. Selective vaginal breech delivery at term–still an option. Acta Obstet Gynecol Scand 2012;91:1177–1183. DOI: 10.1111/j.1600-0412.2012.01488.x.
Bogner G, Strobl M, et al. Breech delivery in the all fours position: a prospective observational comparative study with classic assistance. J Perinat Med 2015;43:707–713. DOI: 10.1515/jpm-2014-0048.
Queenan JT. How to stop the relentless rise in cesarean deliveries. LWW; 2011.
Victora CG, Barros FC. Beware: unnecessary caesarean sections may be hazardous. Lancet 2006;367:1796–1797. DOI: 10.1016/S0140-6736(06)68780-1.
Practice ACoO. ACOG Committee Opinion No. 340. Mode of term singleton breech delivery. Obstet Gynecol 2006;108:235. DOI: 10.1097/00006250-200607000-00058.
Martin JA, Hamilton BE, et al. Births: final data for 2016. 2018
Kotaska A, Menticoglou S, et al. Vaginal delivery of breech presentation: No. 226, June 2009. Elsevier, 2009.