Maternal and fetal risks of planned vaginal breech delivery vs planned caesarean section for term breech birth: A systematic review and meta-analysis.

Background: Breech presentation delivery approach is a controversial issue in obstetrics. How to cope with breech delivery (vaginal or C-section) has been discussed to find the safest in terms of morbidity. The aim of this study was to assess the risks of foetal and maternal mortality and perinatal morbidity associated with vaginal delivery against elective caesarean in breech presentations, as reported in observational studies. Methods: Studies assessing perinatal morbidity and mortality associated with breech presentations births. Cochrane, Medline, Scopus, Embase, Web of Science, and Cuiden databases were consulted. This protocol was registered in PROSPERO CRD42020197598. Selection criteria were: years between 2010 and 2020, in English language, and full-term gestation (37-42 weeks). The methodological quality of the eligible articles was assessed according to the Newcastle-Ottawa scale. Meta-analyses were performed to study each parameter related to neonatal mortality and maternal morbidity. Results: The meta-analysis included 94 285 births with breech presentation. The relative risk of perinatal mortality was 5.48 (95% confidence interval (CI) = 2.61-11.51) times higher in the vaginal delivery group, 4.12 (95% CI = 2.46-6.89) for birth trauma and 3.33 (95% CI = 1.95-5.67) for Apgar results. Maternal morbidity showed a relative risk 0.30 (95% CI = 0.13-0.67) times higher in the planned caesarean group. Conclusions: An increment in the risk of perinatal mortality, birth trauma, and Apgar lower than 7 was identified in planned vaginal delivery. However, the risk of severe maternal morbidity because of complications of a planned caesarean was slightly higher.

Asistencia al parto inminente extrahospitalario. Actuaciones durante este proceso y cuidados a la madre y al recién nacido / Imminent out-of-hospital birth assistance. Actions during this process and care for the mother and the newborn

La atención de un parto precipitado que acontece de forma rápida en un entorno que no es el de un centro sanitario especializado siempre es una situación estresante, básicamente por dos motivos, en primer lugar porque las personas implicadas en su atención, aunque están acostumbradas a la asistencia sanitaria urgente no suelen ser especialistas en obstetricia y al manejo del mismo y en segundo lugar, un parto inminente en tal escenario comporta un riesgo potencial tanto de la vida de la madre como del recién nacido si no se actúa de forma rápida y segura; de ahí la utilidad de una guía actualizada en la atención y administración de cuidados a mujeres embarazadas que paren fuera del ámbito hospitalario, tanto a ella como al recién nacido

Assisting an unexpected birth that occurs quickly in a setting that is not a specialized health center is always a stressful situation, basically for two reasons; firstly, because the people involved in this type of care, although they are used to urgent health care, are not usually specialists in obstetrics and the management of the same and, secondly, because an imminent delivery within such a scenario involves a potential risk for both the life of the mother and the newborn if there is no quick and safe action; hence the usefulness of an updated guide for the assistance and administration of care to pregnant women who give birth outside the hospital environment, both to her and the newborn