breech in nulipara

From: RAUL DORBECKER (74173.437@CompuServe.COM)
Tue Dec 3 21:51:34 1996

>FROM: "Sing-Hung Chang", INTERNET:changl@cariari.ucr.ac.cr
>TO: Multiple recipients of list, INTERNET:OB-GYN-L@TALK.OBGYN.NET
>DATE: 2/12/96 5:23 PM

>Re: breech in nulipara

>How do you manage a nullipara with a breech presentation at term?
>Sing-Hung Chang
>Resident

The perinatal morbidity and mortality in breech presentation are greater than vertex (1-2). I think this is why the majority of Ob-Gyn physician practice C-Section in breech presentation.

At present is recommend C-Section in fetus underage 32 week in breech presentation, because a greater frequency of intraventricular hemorrhage (3). At term, the C-Section is no justifiable only for the breech presentation. The vaginal delivery, in breech presentation at term, is safety. The C-section systematic in breech presentation at term, increase the morbidity and mortality maternal, and social costly, but not offer a benefit to the fetus (4).

J.G.M.Robertson MD wrote: "offer this patient a trial of labour if": 1) it was a frank or complete breech 2) the baby was not overly large (>4000g) 3) the head was flexed

and I add: 4) It must not be assist only by one physician. 5) Medicate epidural anesthesia. 6) Knowledge the use of Piper forceps (if necessary). 7) A good staff in neonato. 

--
Raul Dorbecker
Ob-Gyn Private Practice
Mexico City
E-mail: 74173.437@compuserve.com


(1) Brenner, Bruce, Hendrich. The characteristics and perils of breech
presentation. Am J Obstet Gynecol 1974;118:700.
(2) Wright RC. Reduction of perinatal mortality and morbidity in breech delivery
through routine use of Cesarean section. Obstet Gynecol 1959;14:758
(3) Main DM, Main EK, Maurer MM. Cesarean section versus vaginal delivery for
the breech fetus weighing less than 1,500 grams. Am J Obstet Gynecol 1983;
146:580
(4) C.P.Weiner. Clinical Obstetrics and Gynecology, Vol.3, No. 3, 1992



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