Spontaneous cephalic version and risk factors for persistent breech presentation: a longitudinal retrospective cohort study.

AIMS: To address the rate of spontaneous version in breech presentation until term and explore the risk factors for persistent breech presentation diagnosed by the second-trimester ultrasound examination. METHODS: This is a retrospective cohort study of pregnant women with a singleton pregnancy who had their ultrasound examination conducted at the time of 22-26 weeks of gestation in the Guangzhou Women and Children's Medical Center. Cox regressions were applied to determine the strength of association between selected risk factors and persistent breech presentation. RESULTS: Among 25,313 pregnant women eligible for analysis, the prevalence of breech presentation was 36.8% (9,306/25,313) at 22-26 weeks of gestation, 4.2% (376/8,876) of which would remain in the breech presentation at the onset of labor (adjusted odds ratio [aOR], 0.39, 95% confidence interval [CI], 0.17-0.88). Multiparity (aOR, 0.39, 95% CI, 0.30-0.52) and longer gestational weeks at delivery (aOR, 0.50, 95% CI, 0.44-0.56) were associated with a lower risk of persistent breech presentation (PBP). Female fetus, lateral or fundal placenta, and known uterine malformation was each associated with an increased odd of 1.4 (aOR, 95% CI, 1.11-1.70), 2.4 (aOR, 95% CI,1.50-3.73), 3.1 (aOR, 95% CI, 1.71-5.53) and 8.7 (aOR, 95% CI, 3.84-19.84) times in the persistent breech presentation, respectively. CONCLUSION: The prevalence of the breech presentation was 36.8% between 22 and 26 weeks of gestation, and approximately 4% would have been in the persistent breech presentation until the onset of labor. Higher educational attainment, multiparity and longer gestational weeks at delivery were significantly decreasing the risk of persistent breech presentation. While the pregnant women with age >40 years, female fetus, lateral or fundal placenta and known uterine malformation were associated increased risk of persistent breech presentation.

Congenital anomalies in breech presentation: A nationwide record linkage study.

Our study aimed to determine if congenital anomalies are associated with breech presentation at delivery. We conducted a nationwide, retrospective population-based record linkage study and analyzed all singleton births in Finland from 1996 to 2016 using the mandatory health register data collected by the Finnish Institute for Health and Welfare. We compared all major congenital anomalies detected during pregnancy, birth, or the first year of life according to the fetus's presentation at the time of delivery using X2 -square statistic and Student's t test. We adjusted the results for known risk factors for congenital anomalies to estimate adjusted odds ratios and 95% confidence intervals. Fetuses in breech presentation at delivery had an increased risk for congenital anomalies (6.5%) compared with fetuses in cephalic presentation (3.6%), P < .001. Breech presentation was associated with nearly all types of examined congenital anomalies. The strongest associations were observed with congenital deformities of the hip, the central nervous system, the respiratory system, and the musculoskeletal system. Our study supports the theory that breech presentation is, in many cases, a symptom of a fundamental problem in fetal morphogenesis or function. Neonates born in the breech presentation have a higher risk of congenital anomalies and should undergo a postnatal screening.

Is hysteroscopic metroplasty using the incision method for septate uterus a risk factor for adverse obstetric outcomes?

AIM: This study aimed to assess whether hysteroscopic metroplasty using the incision method for septate uterus is a risk factor for adverse obstetric outcomes during pregnancy or delivery. METHODS: This retrospective, single-center cohort study of obstetric complications included 41 patients with recurrent pregnancy loss or unexplained infertility who underwent hysteroscopic metroplasty using the incision method for septate uterus. As controls, we recruited 1139 women who delivered at our hospital during the same period. The primary outcomes were mean weeks of delivery, mean birthweight, rate of cesarean section, rate of breech presentation, rate of post-partum hemorrhage, rate of preterm delivery, rate of placental abruption, rate of placenta previa, rate of placenta accreta and uterine rupture during pregnancy and delivery. RESULTS: The two groups did not differ in terms of age, mean weeks of delivery, mean birthweight, rate of post-partum hemorrhage, rate of preterm delivery, rate of placental abruption, rate of placenta previa or rate of placenta accreta. The rates of cesarean section and breech presentation were significantly higher in the study group than in the control group (56.1 vs 27.7%; P = 0.0002 and 19.5 vs 6.8%; P = 0.007, respectively). There were no cases of uterine rupture during pregnancy or delivery following hysteroscopic metroplasty. CONCLUSION: Hysteroscopic metroplasty using the incision method for septate uterus is not a risk factor for adverse obstetric outcomes. No severe complications, such as placenta abruption, placenta previa, placenta accreta, uterine rupture or heavy hemorrhage, were observed in the postoperative live birth group.

Prevalence and Perinatal Outcomes of Singleton Term Breech Delivery in Wolisso Hospital, Oromia Region, Southern Ethiopia: A Cross-Sectional Study.

Background: Breech deliveries have always been topical issues in obstetrics. Neonates undergoing term breech deliveries have long-term morbidity up to the school age irrespective of mode of delivery. Objective: To determine prevalence and perinatal outcomes of singleton term breech delivery. Methods: Hospital based cross-sectional study was conducted on 384 participants retrospectively. Descriptive and analytical statistics was used. Result: A total of 384 breech deliveries were included. Prevalence of singleton breech deliveries in the hospital was 3.4%. The perinatal outcome of breech deliveries was 322 (83.9%). Adverse perinatal outcome of singleton term breech delivery was significantly associated with women's age of greater than or equal to 35 years (AOR = 2.62, 95% CI = 1.14-6.03), fully dilated cervix (AOR = 0.48, 95% CI = 0.25-0.91), ruptured membrane (AOR = 5.11, 95% CI = 2.25-11.6), and fetal weight of <2500 g (AOR = 6.77, 95% CI = 3.22-14.25). Conclusion: Entrapment of head, birth asphyxia, and cord prolapse were the most common causes of perinatal mortality. Factors like fetal weight <2500 gm, mothers of age 35 years and above, those mothers not having a fully dilated cervix, and mothers with ruptured membrane were associated with increased perinatal mortality.

Health outcomes of neonates with osteogenesis imperfecta: a cross-sectional study.

OBJECTIVE: To assess at-birth health outcomes of neonates with osteogenesis imperfecta (OI). STUDY DESIGN: A total of 53 women who self-reported having had at least one child with OI completed the survey. We evaluated pregnancy length, neonatal intensive care unit (NICU) usage, at-birth complications, and the child's clinical information including OI type, height and weight. RESULTS: Information was gathered on a total of 77 children (60 type I, 4 type III and 13 type IV). Health conditions reported at birth included breech presentation (24%), prematurity (27%), fracture (18%), bone deformity (18%) and respiratory problems (22%). Approximately 31% (n = 24) received NICU care. There was a significant association between younger maternal age, preterm delivery and NICU admission. CONCLUSION: Our findings suggest that newborns with OI appear to be at high risk of skeletal disorders, preterm delivery and breech presentation. Younger maternal age and preterm delivery seem to be strong predictors of the need for NICU care. Our data suggest that pregnant women with OI younger than 20 years of age may benefit from added clinical supervision in anticipation of adverse effects on their child.

Pituitary stalk interruption syndrome in 59 children: the value of MRI in assessment of pituitary functions.

Pituitary imaging abnormality is a specific indicator of hypopituitarism. This study involved a retrospective review of 59 children diagnosed with pituitary stalk interruption syndrome (PSIS). Of the 59 eligible patients, 54 were born by breech delivery, and there was a significant difference between numbers of patients with breech and head-presenting birth. In order to discuss the relationship between pituitary functions and delineation of pituitary structure in magnetic resonance imaging (MRI), a control analysis was carried out in children with PSIS. Fifty-nine children were subdivided into two groups: group I (partial PSIS, 20 cases) and group II (complete PSIS, 39 cases). There was a significantly small anterior pituitary in both groups of PSIS compared with controls (P < 0.001). The incidence of ectopic posterior pituitary (EPP) was significantly higher in group II (P < 0.001). Before and after hormone replacement therapy, pituitary functions were measured and compared with controls. The levels of growth hormone (GH), free thyroxine (FT4), thyroid-stimulating hormone (TSH), adrenocorticotropic hormone (ACTH), and cortisol (COR) were significantly lower in group II (P < 0.05). The dosage of levothyroxine sodium in group II was significantly higher than in group I (P < 0.01). Conclusion. On the basis of birth history, breech presentation may a forewarning for subsequent pituitary hormone deficiencies. Grades of MRI can predict occurrence and severity of PSIS, which are also correlated with the levels of the pituitary target hormone deficiencies. Interruption of pituitary stalk and ectopic posterior pituitary both represent important markers of pituitary structure and function.

Thyroid diseases and adverse pregnancy outcomes in a contemporary US cohort.

CONTEXT: Thyroid diseases are inconsistently reported to increase risk for pregnancy complications. OBJECTIVE: The objective of this study was to study pregnancy complications associated with common and uncommon thyroid diseases. DESIGN, SETTING, AND PARTICIPANTS: We analyzed singleton pregnancies (N = 223 512) from a retrospective US cohort, the Consortium on Safe Labor (2002-2008). Thyroid diseases and outcomes were derived from electronic medical records. Multivariable logistic regression with generalized estimating equations estimated adjusted odds ratios (ORs) with 99% confidence intervals (99% CI). MAIN OUTCOME MEASURES: Hypertensive diseases, diabetes, preterm birth, cesarean sections, inductions, and intensive care unit (ICU) admissions were analyzed. RESULTS: Primary hypothyroidism was associated with increased odds of preeclampsia (OR = 1.47, 99% CI = 1.20-1.81), superimposed preeclampsia (OR = 2.25, 99% CI = 1.53-3.29), gestational diabetes (OR = 1.57, 99% CI = 1.33-1.86), preterm birth (OR = 1.34, 99% CI = 1.17-1.53), induction (OR = 1.15, 99% CI = 1.04-1.28), cesarean section (prelabor, OR = 1.31, 99% CI = 1.11-1.54; after spontaneous labor OR = 1.38, 99% CI = 1.14-1.66), and ICU admission (OR = 2.08, 99% CI = 1.04-4.15). Iatrogenic hypothyroidism was associated with increased odds of placental abruption (OR = 2.89, 99% CI = 1.14-7.36), breech presentation (OR = 2.09, 99% CI = 1.07-4.07), and cesarean section after spontaneous labor (OR = 2.05, 99% CI = 1.01-4.16). Hyperthyroidism was associated with increased odds of preeclampsia (OR = 1.78, 99% CI = 1.08-2.94), superimposed preeclampsia (OR = 3.64, 99% CI = 1.82-7.29), preterm birth (OR = 1.81, 99% CI = 1.32-2.49), induction (OR = 1.40, 99% CI = 1.06-1.86), and ICU admission (OR = 3.70, 99% CI = 1.16-11.80). CONCLUSIONS: Thyroid diseases were associated with obstetrical, labor, and delivery complications. Although we lacked information on treatment during pregnancy, these nationwide data suggest either that there is a need for better thyroid disease management during pregnancy or that there may be an intrinsic aspect of thyroid disease that causes poor pregnancy outcomes.

Breech presentation and the cornual-fundal location of the placenta.

AIM: To investigate the association of cornual-fundal location of the placenta and breech presentation at term delivery. METHODS: This study was conducted at the Department of Obstetrics and Gynecology, Novi Sad, in 2011. The inclusion criteria were delivery at ≥37 weeks of gestation, singleton gestation, and cornual-fundal location of the placenta determined by ultrasonography at ≥37 weeks of gestation when 3/4 or more of the placenta was in the cornual-fundal region. RESULTS: Out of 2750 ultrasound examinations performed, 143 showed cornual-fundal location of the placenta (frequency 5.2%). Eighty six cases had cephalic presentation (60.14%) and 57 (39.86%) had breech presentation. Of the remaining cases with non- cornual-fundal location, 2585 had cephalic presentation and 22 (0.84%) had breech presentation. The difference in the frequency of breech presentation between the cornual-fundal and non-cornual-fundal groups was significant (χ(2)=77.78, P<0.001). CONCLUSION: Cornual-fundal location of the placenta may be an important clue in resolving the etiology of a number of cases of breech presentation at term delivery.

Uterine synechiae and pregnancy complications.

OBJECTIVE: Uterine synechiae have generally been considered benign findings in pregnancy. We used a large perinatal database to test the hypothesis that uterine synechiae are associated with pregnancy complications. METHODS: We performed a retrospective cohort study of women with singleton pregnancies presenting for routine ultrasonographic examinations at 17-22 weeks from 1990-2009. Pregnancies with multiple fetuses, amniotic bands, and congenital uterine anomalies were excluded. We compared pregnancy outcomes between women with and without uterine synechiae. Multivariable logistic regression was used to adjust for confounders. RESULTS: Of 65,518 pregnancies meeting inclusion criteria, 296 (0.45%) were diagnosed with uterine synechiae. Women with uterine synechiae were significantly more likely to have placental abruption (2.1% compared with 0.6%, adjusted odds ratio [OR] 3.25, 95% confidence interval [CI] 1.43-7.36), preterm premature rupture of membranes (PROM) (5.5% compared with 2.3%, adjusted OR 2.51, 95% CI 1.51-4.18), and cesarean delivery for malpresentation (5.1% compared with 3.0%, adjusted OR 1.75, 95% CI 1.04-2.95). The risks of placenta previa, fetal growth restriction, stillbirth, and preterm delivery were not significantly different. CONCLUSION: Uterine synechiae are associated with significant increase in the risk of preterm PROM, placental abruption, and cesarean delivery for malpresentation. The notion of uterine synechiae as benign findings in pregnancy should be re-evaluated. LEVEL OF EVIDENCE: II.

Mode of delivery and outcomes in preterm births.

OBJECTIVE: To compare maternal and neonatal outcomes by mode of delivery in preterm births. MATERIAL AND METHOD: This prospective study was a part of SEA-ORCHID project of 9,263 pregnant women. The subjects were all women admitted for preterm birth (20 to 36 weeks) in nine hospitals in four Southeast Asian countries (Thailand, Malaysia, Indonesia, and the Philippines) between June 2007 and December 2009. Deliveries were classified into vaginal delivery and caesarean delivery. We obtained data from women's medical and delivery records. RESULTS: There were 765 preterm births in this analysis, 294 (38.4%) were delivered by caesarean section with a mean weight of 1,988 +/- SD 629 g and 471 (61.6%) were delivered vaginally with a mean weight of 1,982 +/- SD 699 g. There were two maternal deaths in caesarean delivery group. Caesarean delivery was significantly associated with increased risk of blood loss > 500 ml and > 1,000 ml, adjusted ORs: 11.7, CI 95%: 5.7-24.1 and 12.0, CI 95%: 2.2-65.3, respectively. Infants delivered vaginally had a significantly shorter length of hospital stay than infant delivered by caesarean delivery (adjusted mean difference 3.4, CI 95%: 1.2-5.5). The risk of respiratory distress syndrome, birth asphyxia (low Apgar scores (< 7) at 5 minutes) and early neonatal death were not statistically different between caesarean delivery and vaginal delivery. CONCLUSION: In preterm births, caesarean delivery significantly increases the risk of postpartum hemorrhage and had longer neonatal length of hospital stay compared to vaginal delivery.

Successful pregnancies in two women with hypoplastic left heart syndrome.

OBJECTIVE: Hypoplastic left heart syndrome (HLHS) is a relatively common complex congenital heart defect. Prior to development of staged reconstruction (i.e., Norwood procedure), HLHS was almost universally fatal within months of birth. Early survivors of the Norwood procedure are now reaching reproductive age. We report successful pregnancies in two such women. PATIENTS: The first patient was a 20-year-old woman transferred from a community hospital at 33 3/7 weeks gestation because of preterm labor, suspected preeclampsia, and mild chronic hypoxemia. She had normal systemic ventricular shortening without significant valvar regurgitation but severe neoaortic dilatation. A fetal ultrasound demonstrated intrauterine growth restriction. An urgent Cesarean section was performed at 33 6/7 weeks gestation, given breech position and intractable preterm labor. The second patient, a 23-year-old woman followed at this institution through pregnancy, presented with preterm labor at 36 weeks gestation. Her systemic ventricular shortening was normal, with mild tricuspid regurgitation but without neoaortic dilation or regurgitation. She developed active labor at 36 3/6 weeks, and had a spontaneous vaginal delivery of a small for gestational age infant. Both women tolerated labor and childbirth without complication. Neither infant had evidence of structural heart disease on fetal echocardiography or physical examination. CONCLUSIONS: These cases, the first reported successful pregnancies in mothers with HLHS, highlight the challenges of pregnancy among women with complex congenital heart disease in general and raise several considerations specific to HLHS.

High thyrotrophin levels at end term increase the risk of breech presentation.

OBJECTIVE: To study the relationship between maternal thyrotrophin (TSH) and breech presentation at term. DESIGN: Combined data sets of two prospective studies to obtain adequate epidemiological power. PATIENTS: One thousand and fifty-eight healthy pregnant women (58 breech, 1000 cephalic) and 131 women who presented in breech at an obstetrical outpatient clinic. MEASUREMENTS: Maternal thyroid parameters [TSH, free thyroid hormone (FT4), thyroid peroxidase antibody (TPO-Ab)] and foetal presentation were assessed in both groups between 35 and 38 weeks gestation. Power calculations suggested that at least 148 breech cases were required. RESULTS: The characteristics of the women in breech in both samples were similar. Women in breech (n = 58 + 131) had significantly higher TSH (but not FT4) than those (n = 1000) with cephalic presentation (Mann-Whitney U-test, P = 0·003). Different cut-offs were used to define high TSH in the 916 TPO-Ab-negative women with cephalic presentation: the 90th, 95th and 97·5th percentiles were 2·4 mIU/l (n = 149), 2·7 mIU/l (n = 77) and 3·2 mIU/l (n = 37). The prevalence rates of breech presentation in these women were all higher compared to the prevalence of breech in women below these cut-offs (df = 1, P < 0·01). The relative risk of the 149 women with a TSH >90th percentile (>2·4 mIU/l) to present in breech was 1·82 (95% CI: 1·30-2·56). CONCLUSIONS: Women with high TSH at end term are at risk for breech presentation. Substantial evidence for a relation between breech presentation and neurodevelopmental delay exists. As high TSH during gestation has also been linked to poor neurodevelopment, the relation between breech presentation and poor neurodevelopment might be thyroid-related.

Maternal thyroid function during gestation is related to breech presentation at term.

OBJECTIVE: To study the relationship between suboptimal maternal thyroid function during gestation and breech presentation at term. DESIGN: Prospective follow-up study during three trimesters of gestation. PATIENTS: A total of 1058 Dutch Caucasian healthy pregnant women were prospectively followed from 12 weeks gestation until term (>or=37 weeks) delivery. MEASUREMENTS: Maternal thyroid parameters [TSH, free T4 (FT4) and auto-antibodies to thyroid peroxidase] were assessed at 12, 24 and 36 weeks gestation as well as foetal presentation at term. RESULTS: At term, 58 women (5.5%) presented in breech. Compared with women with foetuses in the cephalic position, those women who presented in breech at term had significantly higher TSH concentrations, but only at 36 weeks gestation (P = 0.007). No between group differences were obtained for FT4 level at any assessment. The prevalence of breech presentation in the subgroup of women with TSH >or= 2.5 mIU/l (90th percentile) at 36 weeks gestation was 11%, compared with 4.8% in the women with TSH < 2.50 mIU/l (P = 0.006). Women with TSH below the 5th percentile had no breech presentations. Breech position was significantly and independently related to high maternal TSH concentration (>or=2.5 mIU/l) at 36 weeks gestation (O.R.: 2.23, 95% CI: 1.14-4.39), but not at 12 and 24 weeks gestation. CONCLUSIONS: Women with TSH levels above 2.5 mIU/l during end gestation are at risk for breech presentation, and as such for obstetric complications.

La malposición fetal occipito-posterior. Revisión bibliográfica / Occipito-posterior foetal position. Bibliographic review

Objetivo: revisión bibliográfica sobre la malposición fetal occipito-posterior, a fin de obtener una actualización de los conocimientosde la comunidad científica sobre la malposiciónfetal OP.Material y método: revisión bibliográfica realizada durante elmes de enero de 2009, analizando ensayos clínicos, estudiosprospectivos casos-control, estudios retrospectivos y estudiosde casos, así como revisiones bibliográficas, sobre la incidenciade la malposición fetal OP, factores que influyen en suincidencia, métodos de diagnóstico, complicaciones asociadasa la misma e intervenciones que se realizan para corregirlao mejorar los resultados materno-fetales. Las palabrasclave usadas en la búsqueda han sido occipito-posterior y occipitoposterior.Se han consultado las siguientes bases de datos:PubMed, CUIDEN, SCIELO, LILACS y GOOGLE Académico.Resultados: la incidencia de esta malposición es del 15-40%al inicio del parto, rotando la mayoría espontáneamente a occipito-anterior, quedando el 1,8-6% de occipito-posteriorespersistentes. Se relaciona con anomalías pélvicas maternas,nuliparidad, cesáreas previas, recurrencia en siguientes partos,implantación posterior placentaria, embarazo prolongado,administración de analgesia epidural y oxitocina, peso fetaly anomalía del eje fetal. Para su diagnóstico es más precisala ecografía que la exploración manual, aunque ésta puede serfiable en unidades de partos sin dotación de ecógrafo. Estamalposición incrementa la duración de la primera y segundafases del parto, el dolor persistente de espalda, partos instrumentales,cesáreas, episiotomías, lesiones perineales y del esfínteranal, así como valoraciones neonatales más bajas al nacimiento.Para corregir esta posición fetal se usa la rotacióninstrumental mediante fórceps y vacuo, rotación manual y corrección (..) (AU)

Objective: bibliographic review on occipito-posterior foetal position,with the aim of acquiring updated knowledge from thescientific community concerning OP foetal position.Material and method: bibliographic review performed duringthe month of january 2009, analyzing clinical trials, case-controlprospective studies, retrospective studies and case studies,as well as bibliographic reviews on the OP foetal position,factors which influence its incidence, diagnostic methods, associatedcomplications, and interventions that are employedto correct it or improve maternal-foetal outcomes. The keywords used in the search have been occipito-posterior and occipitoposterior.The following databases have been consulted:PubMed, CUIDEN, SCIELO, LILACS and AcademicGOOGLE.Results: the incidence of this position is 15-40% at the onsetof labour. In most cases the foetus rotates spontaneously to anoccipito-anterior position, but in 1,8-6% of cases the occipito-posterior position persists. It is related with maternal pelvicanomalies, nulliparity, prior C-sections, recurrence in followinglabours, posterior placental implantation, prolongedpregnancy, administration of epidural analgesia and oxytocin,foetal weight and abnormal foetal axis. For its diagnosis ultrasoundis more accurate than manual exploration, eventhough the latter may be more reliable in labour units withoutultrasound equipment. This position increases the duration ofthe first and second phases of labour, persistent back pain, instrumentallabour, C-sections, episiotomies, perianal and analsphincter lesions, as well as lower score neonatal assessmentsat birth. In order to correct this foetal position, instrumentalrotation is employed using forceps and vacuum extraction,manual rotation and manual correction of the foetal axis, aswell modification of the maternal posture. (..) (AU)

Assisted fertilization and breech delivery: risks and obstetric management.

BACKGROUND: Previous studies have suggested that assisted reproduction technology (ART) is associated with increased risk of breech presentation. We investigated whether factors that tend to differ between ART and spontaneously conceived pregnancies may explain the higher risk of breech deliveries associated with ART. MATERIAL AND METHODS: In this population-based cohort study, we included 1 209 151 singleton pregnancies reported to the Medical Birth Registry of Norway between 1984 and 2006 and compared the risk of breech presentation in 8229 ART pregnancies with that in spontaneously conceived pregnancies. Risk ratios (RR), adjusted for maternal age, parity, gestational length and year of birth, were estimated using binominal regression, and we describe differences and time trends in obstetric management for breech and cephalic presentations after ART compared with management of spontaneously conceived pregnancies. RESULTS: Breech presentation occurred nearly 50% more often in ART singleton pregnancies than in spontaneously conceived singletons [crude RR: 1.48, 95% confidence interval (CI): 1.34-1.64], but after adjustment for potentially confounding factors, the difference was fully attenuated (RR: 0.97, 95% CI: 0.88-1.07). The most important contributors to the attenuation were parity and length of gestation. In general, Caesarean sections and induced deliveries were more likely in ART pregnancies, but over the study period, the proportion of Caesarean sections in ART pregnancies gradually approached that of spontaneously conceived pregnancies. CONCLUSION: Increased risk of breech presentation in pregnancies after ART is mediated by lower parity and shorter gestational length. In general, the obstetric management of women with ART pregnancies is gradually approaching the ordinary surveillance of pregnant women.

Adverse obstetric outcomes at term after hysteroscopic metroplasty.

STUDY OBJECTIVE: To estimate obstetrical complications at term after hysteroscopic metroplasty for septate uterus. DESIGN: A retrospective comparative study (Canadian Task Force classification II-2). SETTING: La Conception Hospital, Department of Obstetrics and Gynecology, Marseille, France. PATIENTS AND INTERVENTIONS: Thirty-one women who had a term pregnancy from January 1996 through December 2004 after hysteroscopic metroplasty for septate uterus (group A) were studied retrospectively. A control group (group B) of 62 women was selected from the same database who had term pregnancies and no history of hysteroscopic metroplasty. MEASUREMENTS AND MAIN RESULTS: Obstetric complications at term and neonatal outcomes after hysteroscopic metroplasty were compared between 2 groups. The rate of fetal malpresentation was significantly higher in group A versus group B (11/31 [35.5%] vs 0/62, p < .001). Mean birth weight was significantly lower in group A versus group B (2940 g +/- 52 vs 3266 g +/- 456, p =.002). The rate of caesarean section was significantly higher in group A versus group B (19/31 [61.3%] vs 4/62 [6.4%], p < .001). CONCLUSION: The results of this study suggest that patients with a previous hysteroscopic metroplasty for septate uterus are at increased risk for fetal malpresentation at term, low birth weight infants, and delivery by caesarean section and should therefore be informed of these risks before delivery.

Coiling characteristics of umbilical cords in breech vs. vertex presentation.

OBJECTIVE: To compare selected umbilical cord parameters, especially cord coiling, between breech and vertex presentations. METHODS: We prospectively collected umbilical cords from uncomplicated breech and vertex obtained during elective term cesarean deliveries. We compared various cord parameters between the two groups as well as data regarding obstetric history and pregnancy outcome. RESULTS: We evaluated 55 umbilical cords from breech and 55 from vertex deliveries. Umbilical cord length (56.93 cm vs. 63.95 cm, P=0.05), number of coils (5.1+/-0.4 vs. 11.7+/-0.6, P<0.0001) and umbilical cord index (UCI) (0.09 coils/cm vs. 0.18 coils/cm, P<0.0001) were all significantly lower for breech presentations and remained significant following multivariate analysis. CONCLUSION: We document significant differences in umbilical coiling and the UCI between breech and vertex presentation. The precise reason for these differences is still unclear.

Does a probability of breech presentation of more than 50% exist among diseases and medical conditions?

The aim was to study the effect of twin gestations in a uterus with 2 bodies on the probability of breech presentation at delivery. The hypothesis was that the probability of breech presentation was not higher than 50%. A review was undertaken of MEDLINE (1966-2004) and of the article reference list for statistical analysis of presentation at delivery among twins in a normal uterus, singleton gestations in a uterus with 2 bodies, and case studies of twins in a uterus with 2 bodies. There are 10 studies of twin gestations in a normal uterus (Twin A 3036 cases, breech presentation 22.36%; Twin B 2758 cases, breech presentation 36.87%), 2 studies of singleton gestations in a uterus with 2 bodies (297 cases, breech presentation 42.09%), and 57 case report studies of twin gestations in a uterus with 2 bodies (Twin A 56 cases, breech presentation 14.29%; Twin B 54 cases, breech presentation 18.52%). The odds ratio and chi-square test for differences in probabilities show a significantly lower incidence of breech presentation for twins in a uterus with 2 bodies compared with twins in a normal uterus (Twin A, odds ratio = 0.58; chi(2) = 2.08, p > .05, Twin B, odds ratio = 0.39, chi(2) = 7.67, p < .05), and singleton gestations in a uterus with 2 bodies (Twin A, odds ratio = 0.23, chi(2) = 15.51, p < .05; Twin B, odds ratio = 0.31, chi(2) = 10.72, p < .05). Twin gestations in a uterus with 2 bodies decrease the probability of breech presentation.

Outcomes of external cephalic version and breech presentation at term, an audit of deliveries at a Sydney tertiary obstetric hospital, 1997-2004.

BACKGROUND: Probabilistic information on outcomes of breech presentation is important for clinical decision-making. We aim to quantify adverse maternal and fetal outcomes of breech presentation at term. METHODS: We conducted an audit of 1,070 women with a term, singleton breech presentation who were classified as eligible or ineligible for external cephalic version or diagnosed in labor at a tertiary obstetric hospital in Australia, 1997-2004. Maternal, delivery and perinatal outcomes were assessed and frequency of events quantified. RESULTS: Five hundred and sixty (52%) women were eligible and 170 (16%) were ineligible for external cephalic version, 211 (20%) women were diagnosed in labor and 134 (12%) were unclassifiable. Seventy-one percent of eligible women had an external cephalic version, with a 39% success rate. Adverse outcomes of breech presentation at term were rare: immediate delivery for prelabor rupture of membranes (1.3%), nuchal cord (9.3%), cord prolapse (0.4%), and fetal death (0.3%); and did not differ by clinical classification. Women who had an external cephalic version had a reduced risk of onset-of-labor within 24 h (RR 0.25; 95%CI 0.08, 0.82) compared with women eligible for but who did not have an external cephalic version. Women diagnosed with breech in labor had the highest rates of emergency cesarean section (64%), cord prolapse (1.4%) and poorest infant outcomes. CONCLUSIONS: Adverse maternal and fetal outcomes of breech presentation at term are rare and there was no increased risk of complications after external cephalic version. Findings provide important data to quantify the frequency of adverse outcomes that will help facilitate informed decision-making and ensure optimal management of breech presentation.