Prognostic parameters for successful external cephalic version

Objective. To improve patient consultation before external cephalic version (ECV) attempt at term by defining prognostic parameters for the success of the procedure.

Methods. This was a prospective observational study set in a university teaching hospital. We prospectively collected demographic and obstetric data from 603 ECV attempts at our center for the period between January 1997 and June 2005. Analysis was performed by stepwise logistic regression of the demographic and obstetric parameters. The main outcome measure was success of ECV attempt.

Results. Success rates were 72.3% and 46.1% for multiparas and nulliparas, respectively. Prognostic parameters associated with successful ECV were amniotic fluid index > 7 cm, multiparity, non-frank breech, non-anterior placental location, and body mass index < 25.

Conclusion. Prognostic parameters, particularly amniotic fluid index and multiparity, can help physicians in counseling parturients before deciding on ECV.     

First trimester PAPP-A MoM values predictive for breech presentation at term of pregnancy

Abstract

Introduction: Our aim was to state the role of first trimester pregnancy-associated plasma protein A (PAPP-A)-multiple of the median (MoM) value as a predictor for breech presentation at term of pregnancy.

Materials and methods: In this retrospective study, we present data for 1100 singleton full-term deliveries that took place in a third-level hospital setting in northeast Italy between January 2004 and July 2007. For each case, PAPP-A, free beta-human chorionic gonadotropin and nuchal translucency were measured during prenatal trisomies screening (between 11 weeks and 13 weeks and 6?d). A wide range of predictive factors for breech presentation at term of pregnancy and other confounding elements were considered.

Results: Of the 1100 singleton deliveries at term considered in our study, 40 babies were in breech presentation. Using bivariate analysis and multivariate logistic regression, a lower PAPP-A MoM than 0.63 (first quartile of our distribution) in the first trimester (OR 2.41, CI.95 1.25–4.67), and placental index at term higher than the median value (OR 2.04, CI.95 1.00–4.17) were proven to be associated with breech presentation at term.

Conclusions: A low PAPP-A during the first trimester was a predictive factor for breech presentation at term of pregnancy. Acknowledging and acting on this predictor could enable improved management of breech foetuses in the future.     

Factors affecting fetal presentation in twin pregnancies across gestation

Abstract

Objective: To describe pregnancy characteristics associated with the occurrence of spontaneous version in twin pregnancies from 20 weeks until delivery.

Study design: Review of ultrasound and pregnancy data for all twin pregnancies delivered >24 weeks by one Maternal–Fetal Medicine practice from June 2005–May 2012. For each 4-week gestational age window, fetal presentations were recorded, as well as the likelihood of the final presentation being vertex for Twin A and vertex for both twins. Case–control analysis was performed to estimate associations between pregnancy characteristics and spontaneous version of Twin A.

Results: A total of 491 twin pregnancies were included. The distribution of fetal presentations changed significantly from 20 weeks to delivery, but the presentation at each gestational age interval was significantly associated with the final position of Twin A and the likelihood of vertex–vertex presentation at delivery. The likelihood of spontaneous version of Twin A decreased from 27.9% after 24–27 6/7 weeks, to 18.8% after 28–31 6/7 weeks, to 8.2% after 32–35 6/7 weeks. Pregnancy characteristics associated with spontaneous version of Twin A were a prior vaginal delivery and increased fetal size of either twin.

Conclusions: The likelihood of spontaneous version of Twin A decreases as pregnancy advances. Parity and increased fetal size are associated with spontaneous version.     

Intravenous salbutamol for external cephalic version

OBJECTIVE: To evaluate the success of external cephalic version (ECV) using an adjusted bolus dose of intravenous salbutamol compared with no tocolysis. METHODS: An open-label randomized study of 114 women with a term breech fetus randomized to receive either an intravenous bolus dose of 0.1 mg salbutamol with further boluses every 5 minutes, as required, before commencing ECV, or no tocolysis. Primary outcomes were successful ECV and rate of cesarean delivery. RESULTS: Salbutamol tocolysis resulted in a higher rate of successful ECV compared with no tocolysis (70.2% [40/57] vs 36.8% [21/57]; RR 1.9, 95% CI 1.3-2.8; P<0.001). Cesarean delivery rate was lower in the salbutamol group compared with the control group (31.6% [18/57] vs 63.2% [36/57]; RR 0.5, 95% CI 0.3-0.8; P=0.001). Salbutamol dose ranged from 0.1-0.4 mg and outcome was not related to dose. CONCLUSION: Adjusted dose intravenous salbutamol tocolysis prior to ECV increases its success rate and reduces the cesarean delivery rate.     

臀位分娩方式的选择

目的降低臀位分娩时围产儿的损伤率及病死率。方法回顾性总结我院妇产科1994-01~2004-12间1 082例臀位分娩的不同分娩方式及母婴预后。结果臀位分娩时围产儿的损伤率及病死率与分娩方式的选择有关;影响分娩方式主要有孕产次、孕周、胎重、胎膜早破、脐带绕颈及胎儿宫内窘迫等因素。结论综合考虑臀位孕妇的孕产次、孕周、胎重、胎膜早破、脐带绕颈及胎儿宫内窘迫等因素,适当放宽剖宫产指征,在条件允许的情况下进行阴道分娩是选择正确分娩方式的关键。     

Femur fracture during abdominal breech delivery

BACKGROUND: While vaginal breech delivery, although rare, can cause femur fracture, abdominal breech delivery is not expected to cause it. CASE: A 2,490-g female infant was delivered at term by elective cesarean section for breech presentation. She sustained a fracture of the femur shaft. A simple splinting led to a complete healing of the fracture without sequelae. CONCLUSION: Although abdominal breech delivery reduces the risk of birth trauma, we must be aware that femur fracture can occur regardless of the mode of delivery.     

Safety of term vaginal breech delivery

Of 247 women who were pregnant of one healthy child in breech presentation at term, 13 (5.3%) were delivered by a primary cesarean section. The other 234 (94.7%) were allowed to attempt vaginal birth. In these women, the only factor to determine the possibility of a vaginal delivery was normal progression of labor during the first stage, without secondary arrest or signs of fetal distress. 109 Women (44.1%) were delivered spontaneously according to Bracht, 87 (35.2%) had an assisted breech delivery, and 38 (15.4%) underwent a secondary cesarean section. There were two perinatal deaths (0.8%). One of them was directly related to the trial of labor. Two children with a birth trauma had an uneventful recovery. The 1 min Apgar score in all breech delivery groups was more often lower than in a control group of children, who were born spontaneously at term in vertex presentation. However, the 5 min Apgar score and the mean umbilical artery pH were within normal limits in all groups. The secondary cesarean section rate was inversely related to vaginal parity of the mother, and directly related to the newborns' birth weight. There was no relation between the secondary cesarean section rate and the type of breech presentation. It is concluded, that a trial of labor in carefully selected patients with a child in breech presentation at term is a safe procedure, that can be successfully completed in almost 80% of cases. In retrospect, low vaginal parity and high birth weight of the newborn have a negative influence on normal progression of labor.     

不同干预措施对胎儿臀位/横位孕妇母婴结局影响的网状Meta分析

背景 胎儿臀位和横位如未得到及时、有效处理可能会增加剖宫产率,且增加子宫破裂等严重分娩并发症的风险,危及母胎生命。然而,对于不同干预措施的有效性对比与选择的优先次序,目前尚无统一结论。目的采用网状Meta分析方法,评价不同干预措施对孕晚期胎儿臀位/横位孕妇母婴结局的影响。方法 计算机检索Cochrane Library、PubMed、Web of Science、Embase、CINAHL、中国生物医学文献数据库(CBM)、中国知网(CNKI)、维普网(VIP)、万方数据知识服务平台中关于不同干预措施对孕晚期胎儿臀位/横位孕妇母婴结局影响的随机对照试验(RCT),检索时间为建库至2022年3月。由2名研究人员独立完成文献筛选和资料提取,并进行文献质量评价。采用R 4.1.1和Stata 16.0软件进行数据分析和图形绘制,首先进行一致性检验与收敛性评估;通过累积排序概率图下面积(SUCRA)呈现不同措施成为最佳干预措施的可能。结果 本研究共纳入36篇文献,包含7 419名产妇。涉及的干预措施有：膝胸卧位、艾灸/刺激至阴穴和不同类型宫缩抑制剂/麻醉方式下实施外倒转术(ECV)。网状Met...     

Pulmonary and systemic cerebellar tissue embolism due to birth injury

Summary Brain tissue embolism in the coronary, leptomeningeal and pulmonary arteries was discovered microscopically following the autopsy of a female newborn. Death occurred 8 h after breech delivery, which had been complicated by both arms being turned up beside the head. The dislodged brain tissue originated from the left cerebellar hemisphere and had entered the venous blood stream through a rupture of the left sinus transversus. Both paradoxical systemic and pulmonary artery embolization ensued. The baby died from the combined effects of cerebral haemorrhage, pulmonary embolism, myocardial infarction and shock.     

Birth-related spinal cord injuries: a multicentric review of nine cases

Objective The objective of this study was to report a multicentric study of nine cases of children presenting with a birth-related spinal injury. Materials and methods The medical charts of nine patients identified by a questionnaire sent to the members of the French Society of Paediatric Orthopaedics (SOFOP) were reviewed. Conclusions The pregnancy was uneventful in all cases. The fetal presentation was cephalic in three cases, a breech presentation in four cases, a face presentation in two cases. The lesion involved the cervical spine in six cases. Three patients presenting upper cervical injuries died before the age of 6 years. The six remaining patients experienced no neurological improvement. These rare conditions occur during difficult deliveries with abnormal presentations, the most common being a breech presentation with entrapment of the fetal head. In a child with hypotonia, flaccid quadriplegia or high thoracic paraplegia after a difficult delivery, a spinal cord injury must be suspected and plain radiographs and magnetic resonance imaging (MRI) must be performed.