Maternal and fetal outcome in undiagnosed and diagnosed singleton breech presentation at term

To find out the maternal and fetal outcome in undiagnosed and diagnosed singleton breech presentation at term. This study was conducted at Lady Reading Hospital, Peshawar from 1st July 2000 to 30th June 2001 on patients presenting with singleton term breech. Multiple pregnancy and preterm breech were excluded. Information regarding,age, address, parity, gestational age, physical and vaginal examination, ultrasound findings, mode of delivery, any specific procedures performed including external cephalic version [ECV] was collected. Demographic variables and obstetrical outcome were observed in diagnosed and undiagnosed breech cases.Diagnosed breech cases were diagnosed antenatally and proper management plan decided, while undiagnosed breech cases were unbooked who came to hospital for 1st time in labour. Out of 203 cases, 163 [80.29%] patients presented with undiagnosed breech and 40[19.71%] had been diagnosed in antenatal clinic. Out of 163 undiagnosed cases, 137 [84.1%] had successful vaginal breech delivery [VBD], 22 [13.5%] cases had caesarean section [CS], three [1.8%] had subtotal hysterectomy for rupture uterus and 1 [0.6%] with successful ECV had normal vaginal delivery [NVD]. Among 40 diagnosed cases, 8[20%] had successful VBD, 22 [55%] had CS and 10 [25%] had successful ECV followed by NVD. There was no statistical significant difference in short term neonatal outcome, neonatal morbidity and mortality among both groups. Maternal morbidity was lower in vaginally delivered undiagnosed breech cases than in those delivered by caesarean section.In diagnosed group maternal morbidity was the same regardless of mode of delivery. Good prenatal care is essential to reduce undiagnosed breech cases at term. ECVreduces the incidence of Breech Presentation at delivery. In selected cases VBD is a safe option

External cephalic version before elective caesarean section for breech presentation

The Royal College of Obstetrics and Gynaecology guidelines state that all uncomplicated breech presentations should be offered external cephalic version and all such women should be briefed about the risks and benefits of external cephalic version before undertaking the procedure. To ascertain the acceptability of external cephalic version before elective caesarean section for breech presentation by pregnant ladies and see whether they were adequately informed about the risks and benefits. The clinical audit was registered with the audit department at Watford general hospital and written consent for the access of medical records was obtained. A retrospectixre review of 86 accessible medical records out of total 110 elective breech caesarean sections was done over a period of one year. January to December 2006. This retrospective study was conducted at the gynaecology and obstetrics department at Watford general hospital, Watford United Kingdom. Written consent for the access of medical records was obtained. All women who underwent elective caesarean section due to breech presentation were included in the study. Out of a total of 110 elective breech caesarean sections performed, the data on 86 cases was selected for the final analysis. The information gathered included patient's profile, whether patient was informed of risks and benefits of external cephalic version, recognition of obstetric risk factors, external cephalic version performed and its success. Out of total 86 caesarean sections 46 were suitable for external cephalic version of whom 37 cases were offered external cephalic version. Among 37 patients who were offered external cephalic version only 15 patients accepted [22 declined] the procedure. Moreover, it was found that the documentation of risk/benefit explanation of the procedure was inadequate. external cephalic version was not successful in any of the patient. Causes for unsuccessful external cephalic version were abdominal discomfort [51, inability to disengage fetus from pelvis [4], fetal bradycardia [3] and uterine irritability [3]. External cephalic version was not successful in any of the cases in this study. However, to reduce the number of elective caesarean sections for breech presentation, external cephalic version should be offered to all women with uncomplicated breech presentation. Continuing medical education, dissemination of guidelines and regular clinical audit are necessary to improve the success rates of external cephalic version