Pregnancy outcomes in breech presentation at term: a comparison between 2 third level birth center protocols.

BACKGROUND: Medical literature supports planned cesarean delivery for breech presentation at term because of observed reductions in neonatal morbidity and mortality compared with vaginal breech delivery. OBJECTIVE: This study aimed to compare perinatal outcomes of singleton pregnancies with breech presentation at term according to the different delivery protocols of 2 teaching hospitals, where vaginal breech delivery (protocol 1) or cesarean delivery (protocol 2) is routinely offered, respectively. STUDY DESIGN: A retrospective matched cohort study was conducted between January 2015 and May 2021. A total of 1079 women were eligible for analysis. After matching for possible confounding factors, the final analysis was performed on 257 patients in each group. The primary outcomes were a composite of adverse obstetrical outcomes and a composite of neonatal adverse outcomes. RESULTS: Overall, 1079 women were eligible for analysis. After matching for possible confounding factors, the final analysis was performed on 257 patients in each group. The composite of adverse obstetrical outcomes was similar in the 2 groups (24.1% vs 24.5%; P=1.000); however, the composite of neonatal adverse outcomes was significantly higher for protocol 1 (17.9% vs 1.2%; P<.001). No neonatal death or birth trauma was reported in either group. The rates of neonatal intensive care unit admission (4.3% vs 0.4%; P=.004), respiratory distress at birth (17.5% vs 1.2%; P<.001), and Apgar scores of <7 after 5 minutes (5.8% vs 0.4%; P<.001) were significantly higher for protocol 1. CONCLUSION: Short-term, nonsevere adverse neonatal outcomes were significantly increased in the protocol 1 group. These must be balanced against the possible negative effects of cesarean delivery on long-term infant and maternal health.

A Surgical Alternative in the Treatment of Recurrent Diaphragmatic Hernia after Total Gastrectomy.

Treament of hiatal hernia remains a challenge for surgeons. The techniques for treatment started with cruroplasty, which was later associated with extensive mobilization of the esophagus, with or without fundoplication. Other solutions included the use of synthetic or biological mesh and autologous tissue reinforcement. Despite these therapeutic strategies, the recurrence rate for hiatal hernia is significant, and no existing treatments have had much success in reducing this rate. Total gastrectomy, as in this case, represents an additional challenge because of the absence of gastric tissue, which can buttress the pillars' repair. This case report introduces a novel approach for the treatment of recurrent hiatal hernia, using a pedicled vertical rectus abdominis myocutaneous flap.