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Vaginal Breech deliveryFrom: Raymond Stephen (stephen.raymond@dhhs.tas.gov.au)Thu May 25 18:07:49 2006
Vaginal Delivery of Breech Baby Safe Under Specific Circumstances By Martha Kerr NEW YORK (Reuters Health) May 12 - Neonatal outcome of planned vaginal deliveries of breech presentations is virtually the same as the outcome of planned caesarean delivery if strict criteria are met, including pelvimetry and management of labour. Investigators with the PREsentation et MODe d'Accouchment (PREMODA, presentation and mode of delivery) study, led by Dr. Francois Goffinet of the Universite Pierre et Marie Curie in Paris, conducted a prospective study with intent to treat analysis with 2526 women with planned vaginal delivery and 5579 planned caesarean delivery of breech presentations. The main outcome measure was fetal and neonatal mortality combined with severe neonatal morbidity. Of the women planning vaginal deliveries, 71.0% were successful. The rate of the combined adverse outcome was 1.59%. Of the 5,579 planned caesarean deliveries, the combined adverse outcome was about the same, at 1.60%. Strict criteria had to be met to follow through with a planned delivery, Dr. Goffinet pointed out. Pelvimetry was used by 82.4% of physicians in the PREMODA study compared with 9.8% of physicians in comparable settings in national registries. Continuous fetal heart rate monitoring was also performed in the planned vaginal delivery group. A second stage of labour longer than 60 minutes, a significant cause of neonatal complications, occurred in only 0.2% of the planned vaginal delivery group, Dr. Goffinet noted. Active pushing before the presenting part reached the pelvic outlet was used by the PREMODA physicians, which is earlier than recommended in French practice guidelines. Four of infants of planned vaginal deliveries had Apgar scores below four at 5 minutes compared with 1 in the planned caesarean section group. Dr. Goffinet told Reuters Health that complications to the infant and the mother are higher if a rescue caesarean delivery is needed after the baby is engaged, but that the risks are about the same as an infant engaged in a women with a planned caesarean section. These results are published in the April issue of the American Journal of Obstetrics and Gynaecology. Am J Obstet Gynecol 2006;194:1002-1011.
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