Preterm Birth, Low Gestational Age, Low Birth Weight, Parity, and Other Determinants of Breech Presentation: Results from a Large Retrospective Population-Based Study.

Aim of this study is to analyze determinants of breech presentation using information from two regional databases of Lombardy (Italy) including data on consecutive singleton breech and vertex deliveries occurred in the Region, between January 2010 and December 2015. Breech presentation occurred in 3.8% of all single deliveries. Main determinants of breech presentation at birth were: gestational age and birth weight (the lower, the higher the incidence of breech presentation), maternal age (the older the mother, the higher the risk of breech presentation), parity (the frequency of breech decreased with increasing parity) and previous cesarean section. Breech presentation resulted more frequent after assisted reproduction procedures.

Neonatal Mortality and Long-Term Outcome of Infants Born between 27 and 32 Weeks of Gestational Age in Breech Presentation: The EPIPAGE Cohort Study.

OBJECTIVE: To determine whether breech presentation is an independent risk factor for neonatal morbidity, mortality, or long-term neurologic morbidity in very preterm infants. DESIGN: Prospective population-based cohort. POPULATION: Singletons infants without congenital malformations born from 27 to 32 completed weeks of gestation enrolled in France in 1997 in the EPIPAGE cohort. METHODS: The neonatal and long-term follow-up outcomes of preterm infants were compared between those in breech presentation and those in vertex presentation. The relation of fetal presentation with neonatal mortality and neurodevelopmental outcomes was assessed using multiple logistic regression models. RESULTS: Among the 1518 infants alive at onset of labor included in this analysis (351 in breech presentation), 1392 were alive at discharge. Among those eligible to follow up and alive at 8 years, follow-up data were available for 1188 children. Neonatal mortality was significantly higher among breech than vertex infants (10.8% vs. 7.5%, P = 0.05). However the differences were not significant after controlling for potential confounders. Neonatal morbidity did not differ significantly according to fetal presentation. Severe cerebral palsy was less frequent in the group born in breech compared to vertex presentation but there was no difference after adjustment. There was no difference according to fetal presentation in cognitive deficiencies/learning disabilities or overall deficiencies. CONCLUSION: Our data suggest that breech presentation is not an independent risk factor for neonatal mortality or long-term neurologic deficiencies among very preterm infants.

Fetal Craniotomy.

Nowadays, even in developing countries Cesarean section is the most common method of delivery for the breech presentation. However, in rural parts of the countries still vaginal route is the only option. Trauma to the after coming head is the common issue among the contributors of birth trauma during breech delivery. Entrapment of after coming head is an unpredictable obstetrical emergency. If the fetus is alive, options from application of obstetric forceps to giving Dührssen incisions can be kept in choice. Cesarean section is done when all the methods fail to deliver the head. But, when the fetus is not salvageable, delivery of after coming head by craniotomy can reduce unnecessary morbidity of Cesarean section. In the present report, a case with entrapment of after coming head of dead preterm fetus for 6 hrs of home delivery was described and the management of this condition was reviewed.

Long-term follow-up for organic dysfunction in breech - presenting children.

BACKGROUND: The authors performed a long term outcome analysis of minimal brain damage in children delivered in breech presentation, and related the results to the mode of delivery (vaginal or by cesarean section). MATERIAL/METHODS: In the Department of Obstetrics at the Medical University of Gdansk (Poland), 917 breech deliveries took place between 1981 and 1990. Excluding stillbirths and multiple pregnancies, 874 deliveries were analyzed. We received positive responses from 232 mothers, who provided us with considerable information about the children's further development and problems that had arisen during their school years. All the respondents were contacted by telephone, and 83 of them agreed to visit our Department with their children to undergo a psychological examination - the following tests were performed: 1) the Bender-Kopitz Test (BKT), and 2) the Benton Visual Retention Test (BVRT). RESULTS: The mode of delivery for all groups and subgroups had no influence on the incidence of organic brain disorders in later childhood, assessed by the Benton Visual Retention test and by the Bender-Kopitz test. CONCLUSIONS: Vaginal breech deliveries are safe in both primiparous and multiparous mothers.

Coiling characteristics of umbilical cords in breech vs. vertex presentation.

OBJECTIVE: To compare selected umbilical cord parameters, especially cord coiling, between breech and vertex presentations. METHODS: We prospectively collected umbilical cords from uncomplicated breech and vertex obtained during elective term cesarean deliveries. We compared various cord parameters between the two groups as well as data regarding obstetric history and pregnancy outcome. RESULTS: We evaluated 55 umbilical cords from breech and 55 from vertex deliveries. Umbilical cord length (56.93 cm vs. 63.95 cm, P=0.05), number of coils (5.1+/-0.4 vs. 11.7+/-0.6, P<0.0001) and umbilical cord index (UCI) (0.09 coils/cm vs. 0.18 coils/cm, P<0.0001) were all significantly lower for breech presentations and remained significant following multivariate analysis. CONCLUSION: We document significant differences in umbilical coiling and the UCI between breech and vertex presentation. The precise reason for these differences is still unclear.

Predictive factors and short-term fetal outcomes of breech presentation: a case-control study.

OBJECTIVE: This study evaluated the predictive factors and short-term fetal outcomes of breech presentation by comparing breech and cephalic pregnancies of >or=36 weeks gestation. MATERIALS AND METHODS: Two hundred and one breech and 149 cephalic pregnancies of >or=36 weeks gestation, with no other maternal or fetal problems, were compared with regard to placental localization, fetal heart rate variability, smoking, body mass index, maternal weight gain, placental weight, birth weight, sex, Apgar scores, and umbilical cord length. RESULTS: Maternal weight gain, body mass index at term, smoking and hemoglobin values were significantly higher in breech presentation than in cephalic pregnancies. The placenta was located in the cornu-fundal region in 63.2% of breech presentations and 26.8% of cephalic presentations (p<0.001). Placental weights were 657 g and 597 g, respectively (p<0.001). Umbilical cord length was shorter in breech than cephalic pregnancies (p<0.001). Although breech pregnancies had significantly reduced fetal heart rate variability (p<0.001), Apgar scores were much higher in breech fetuses than in cephalic fetuses. Ninety-five percent of breech pregnancies underwent cesarean sections. CONCLUSION: Cornu-fundal localization of the placenta, smoking, greater maternal weight gain, higher body mass index at term, greater placental weight, shorter umbilical cord, and lower estimated fetal weight may be predictive of persistent breech presentation. Reduced fetal heart rate variability did not have an adverse effect on Apgar scores after cesarean delivery in breech fetuses with no other problems at term.

[Is the breech presentation and delivery normal or pathological?].

The authors share their opinion, comparing their personal experience with the data in the world literature.

Discrepancy in ultrasound biometric parameters of the head (HC--head circumference, BPD--biparietal diameter) in breech presented fetuses.

BACKGROUND: A comparison of fetal ultrasonographic biometric parameters of the head (head circumference - HC, biparietal diameter - BPD) in breech presented fetuses. METHODS: Ultrasound biometry was performed in accordance with the method presented in the reference tables. In all breech presented fetuses, the HC, BPD and FL (femur length) were measured. High-risk and multiple pregnancies were excluded from the study. RESULTS: A total of 111 ultrasonographic biometries were performed between the 31(st) - 38(th) week of gestation. Fetuses in the breech position had a significantly lower BPD compared to HC and FL. The difference between BPD and HC was 16.2 days (95%Cl 14.3-18.1; p = 0.001). Maternal age at delivery was 20 - 36 years (average 28.1; median 28.0). CONCLUSIONS: According to our results, fetuses in the breech position have a significantly lower BPD compared to HC or FL. HC and FL parameters correlate with gestational age. In cases of ultrasonographic biometric discrepancy between BPD and FL, the fetal position should be taken into account. Breech-presented fetuses have an elongated head shape and ultrasound biometrics should evaluate its circumference (HC). It is important to responsibly interpret the results so as not to stress the expecting mother with suspicions of fetal pathology.