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Re: Breech TrailFrom: Gerald P. Rodríguez (geraldpr@cybermesa.com)Tue Jan 24 15:26:22 2006
Merci, Bernard. This makes a lot of sense. Gerald P. Rodríguez, M.D., FACOG Santa Fe ~~~~~~~~~~~~~ Quien calla otorga. ~~~~~~~~~~~~~~
> ----- Original Message ----- Eberhard, 1 - Our college has stated exactly the opposite (there is not proof that CS is better than VD), 2 - If the RCOG says that I don't understand why there is still one vaginal breech in all english speaking world. 3 - "The results of the trial" quoted in the RCOG recommandation refers to the Hannah's which has been dramatically criticized recently in the grey journal. One author has written it's conclusions "should be withdrawn". I quote the abstract below and the full text article is available on the journal site. BC Am J Obstet Gynecol. Volume 194, Issue 1, Pages 20-25 (January 2006) Five years to the term breech trial: The rise and fall of a randomized controlled trial Marek Glezerman, MD Received 28 May 2005; received in revised form 18 July 2005; accepted 18 August 2005 Objective On the basis of the end points of neonatal morbidity and death, the authors of the term breech trial concluded unequivocally that cesarean delivery was safer for breech babies. Study design Analysis of the original and new data gives rise to serious concerns as far as study design, methods, and conclusions are concerned. In a substantial number of cases, there was a lack of adherence to the inclusion criteria. There was a large interinstitutional variation of standard of care; inadequate methods of antepartum and intrapartum fetal assessment were used, and a large proportion of women were recruited during active labor. In many instances of planned vaginal delivery, there was no attendance of a clinician with adequate expertise. Results Most cases of neonatal death and morbidity in the term breech trial cannot be attributed to the mode of delivery. Moreover, analysis of outcome after 2 years has shown no difference between vaginal and abdominal deliveries of breech babies. Conclusion The original term breech trial recommendations should be withdrawn. Dr Eberhard Lisse wrote: Bernard, I really am starting to doubt you, or rather whether you have a clue. I have done enough breeches to know that *EVERYTHING* is possible. Never mind deflexed head, maternal non-cooperation, nuchal arms, cord prolapse or tissue issues (entrapped head from incomplete cervix). I won't even go into pelvimetry even if the RCOG mentiones it at http://www.rcog.org.uk/index.asp?PageID=513 Although it is possible that careful exclusion of growth restricted infants, better intrapartum monitoring, full pelvimetry and umbilical cord assessment might have improved the prospects for a vaginal breech delivery, the results of the trial lead to an inescapable recommendation that 'the best method of delivering a term frank or complete breech singleton is by planned LSCS'. This is A grade evidence Level Ib. This finding should be disseminated to pregnant women, their families, and all clinicians involved in maternity care. Which I heereby do :-)-O el on 1/24/06 8:00 PM Bernard Cristalli said the following: If the head is small and the pelvis wide it is not possible. Efrain Ramirez a écrit : Bernard - you did not answer my question - At Tue, 24 Jan 2006, Bernard Cristalli wrote: The head must be rather small (ultrasonography) and the pelvis must be rather wide (X-ray pelvimetry). If the the head is obviously (or probably) too big it's a Cs. That's what I meant by "proper selection".
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