A novel and dedicated multidisciplinary service to manage breech presentation at term; 3 years of experience in a tertiary care maternity unit.

OBJECTIVE: In order to provide uniform and unbiased multidisciplinary counselling on the options available, including vaginal breech delivery (VBD) and external cephalic version (ECV), the latter of which could then be performed, a weekly Breech Clinic was introduced to a tertiary care maternity unit in Northern Ireland in June 2013, replacing the traditional ECV Clinic introduced in June 2012. METHODS: Retrospective data collection was undertaken using clinic proformas, Northern Ireland Maternity System data and case notes of women who attended the clinics (ECV and Breech) from June 2012 to May 2015. RESULTS: There were 434 referrals to the clinic over the 3-year period; 356 women attended. The proportion of women attending increased from 69% to 85% since the introduction of the Breech Clinic. Two hundred and thirty-two were deemed eligible and 179 of these underwent ECV after counselling. Although the proportion of women undergoing ECV decreased from 69% to 46%, 11 women opted for and achieved VBD during the 2 years of the Breech Clinic, compared with one woman in the year of the ECV Clinic. Seventy-one of the attempted ECVs were successful, with 61 women having a normal vaginal delivery. Notably, the success rate of ECV increased from 33% to 42%. The number of caesarean sections performed solely for breech at term decreased from 199 in the 12 months before the introduction of ECV clinic, to 188 during the ECV clinic, and 154 in the final 12 months of Breech Clinic. CONCLUSIONS: A dedicated service to counsel women on the management of breech presentation can decrease caesarean sections for breech presentation through increased uptake and success of ECV, and encouraging suitable women to opt for VBD when ECV is unsuccessful, contraindicated or declined.

An assessment of vascularity and flow intensity of the placenta in normal pregnancy and pre-eclampsia using three-dimensional ultrasound.

OBJECTIVE: To test the hypothesis that parameters of vascularity and flow intensity of the placenta as determined by three-dimensional (3D) ultrasound, (1) are different in normal pregnancy compared to pre-eclampsia (2) decrease from the basal plate towards the chorionic plate. METHODS: Twenty women with normal pregnancy and 17 women with pre-eclampisa were studied. 3D power Doppler ultrasound was used to acquire individual placental volumes. Rotational measurements of placental volumes were acquired using virtual organ computer aided analysis (VOCAL). The power Doppler signals were then semi-quantified within 'histogram facility', which generates three vascularity and flow intensity parameters: flow index (FI), vascular index (VI) and vascularisation flow index (VFI). RESULTS: FI, VI and VFI were lower in pre-eclampsia compared to normal pregnancy in all regions of the placenta. This difference was statistically significant in most regions of the placenta after accounting for gestational age, body mass index and placental site. We were not able to demonstrate a decreasing gradient of these parameters from basal plate to chorionic plate. CONCLUSION: 3D ultrasound to assess placental vascularity and flow intensity appears to be an interesting research tool. However, other indices derived from Power Doppler may be more relevant to obstetric practice.