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Re: breech in nuliparaFrom: Ealgail@aol.comMon Dec 2 21:56:16 1996
A breech in a nullip at "term"....if you mean 37 weeks or more, regardless of the "type" of breech, most of us trained within the last 10 or so years were taught to offer the patient an external version under tocolysis. (Quilligan reported the first 200 cases of modern version at term from UCLA at a meeting of the St Louis Gyn Society in 1980) There is a recent article suggesting that the use of IV ritodrine as tocolysis results in more successes than other methods (subq. terbutaline). I quote a success rate of 3 out of 5 for version. Failing that (the two in five), I explain to the patient that she is eligible for a trial of vaginal breech delivery if the fetus meets the criteria already set out in a previous message. If the fetus is a footling or other than a frank breech presentation, I offer a scheduled c/section or a c/section at the onset of labor. For all of these criteria, nullip or multip is irrelevant; they are treated the same. For concerns about the"history" of adverse breech deliveries, I point out that in those studies, the preterm infants were not separated out, and that they didn't have fetal monitoring. Meta analysis of modern studies shows no quality outcome differences in vaginal or abdominally delivered breeches when controlled for gestational age, pre-existing high risk factors, and fetal anomalies. When presented objectively with the options, most patients will follow the protocols as outlined with confidence. Linda Morrison-Boczar, M.D., M.B.A. Assistant Professor, Indiana University School of Medicine
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