Management of breech presentation at term: a retrospective cohort study of 10 years of experience.

OBJECTIVE: To evaluate the impact of management of childbirth (external cephalic version (ECV) plus planned vaginal delivery (PVD)) of breech presentation at term (⩾37 weeks of gestation). STUDY DESIGN: This retrospective cohort study was based on data collected of singleton breech presentations at term in the Obstetrics and Gynaecology Service, Cruces University Hospital (Biscay, Spain), from January 2003 to December 2012. RESULT: We attended 2377 singleton breech pregnancies at term. We attended 1684 singleton breech term deliveries, attempting vaginal delivery after selection in 52.9% of cases and were successful in 57.5% of attempts. A total of 1360 ECV were attempted, with a success rate of 50.3% of those attempted. The use of ECV has decreased the rate of breech presentation at delivery by 39.0%, the rate of breech presentation as a caesarean section (CS) indication by 47.1% (CS due to breech presentation/total of CS) and the rate of CS for breech presentation out of the total of deliveries by 39.1% (CS due to breech presentation/total of deliveries). Early postnatal parameters (5-min Apgar score, umbilical cord arterial pH and acid-base analysis) were significantly lower following PVD compared with planned CS for breech presentation. However, we did not find any differences in the rates of admissions to the neonatal unit or neonatal mortality. CONCLUSION: Management of breech presentation with a protocol that includes ECV, careful selection criteria and active management of vaginal delivery achieve a great decrease in the rate of CS for breech presentation.

[Malignant adenoma of the cervix: a diagnostic and therapeutic dilemma]. / "Adenoma malignum" der Zervix: Ein diagnostisches und therapeutisches Dilemma.

"Adenoma malignum" of the cervix is an extremely rare variant of cervical adenocarcinoma. Its diagnosis by means of light microscopy is rendered very difficult by its strong similarity to benign endocervical hyperplasia. During the last few years immunohistochemistry has proved to be of great help in differential diagnosis. Treatment of "adenoma malignum" also poses great problems. Most cases are diagnosed in advanced stages, although only early diagnosis offers the possibility of effective treatment. Radiotherapy has failed in all known cases in an advanced stage of the disease. Chemotherapy is also not promising as a therapeutical option, because the tumour expresses high levels of the multidrug-resistance marker P-glycoprotein.

[Cerebral metastasis of a cervix carcinoma]. / Zerebrale Metastase eines Zervixkarzinoms.

We present our first case of cerebral metastasis from cervical carcinoma in a living patient after primary treatment of the tumor. The metastasis was surgically removed, with a bad outcome. The lack of guidelines for the treatment of this complication, which is due to its extremely low frequency, is discussed.