External cephalic version after previous cesarean section

Article Abstract:

In a breech vaginal delivery, the buttocks of the infant comes out of the birth canal before the head. This type of delivery is associated with an increased risk of complications during childbirth. Infants in the breech presentation may be delivered by cesarean section or may be repositioned into the head down position to permit normal vaginal delivery. The external cephalic version is a method for converting a breech presentation to a normal vertex position, in which the head is directed down into the birth canal. The use of this technique may reduce the increasing rate of cesarean section due to breech presentation. Studies have shown that external cephalic version can be successfully performed in women who have had previous vaginal deliveries, but is often avoided in patients who have had cesarean sections for fear of rupturing the uterus. The success of external cephalic version was assessed in 56 women with breech presentation who had undergone one or more cesarean sections. Version was successfully performed in 82 percent of the women, and 65 percent of these women delivered vaginally. Version did not cause adverse effects on the fetus or mother. These findings demonstrate that external cephalic version can be performed successfully and safely in women with breech presentation who have had previous cesarean section. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Head entrapment and neonatal outcome by mode of delivery in breech deliveries from twenty-four to twenty-seven weeks of gestation

Article Abstract:

Head entrapment may occur in both vaginal and cesarean deliveries of extremely preterm infants in the breech position. Researchers reviewed the cases of 132 viable infants born from 24 to 27 weeks' gestation who were delivered in the breech position. Four out of 43 vaginally delivered infants experienced head entrapment, as did five of 89 infants delivered by cesarean section. Infants weighing 1000 to 1249 grams had a greater risk of head entrapment or difficult delivery than lighter infants or than infants weighing slightly more. Neither gestational age nor type of breech position were found to be risk factors for head entrapment. Cesarean section delivery may not reduce the occurrence of head entrapment in breech infants, and an extensive incision may be needed in these cases.

Health aspects

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Management of term breech presentation: a protocol of external cephalic version and selective trial of labor

Article Abstract:

Attempts to turn a breech fetus before labor may reduce the number of breech presentations and the cesarean section rate. Researchers reviewed the cases of 464 women with fetuses in the breech presentation. Women were asked if they wanted doctors to attempt to turn the fetus after the 36th week of pregnancy and before active labor. A total of 344 of 382 breech presentations diagnosed before labor received attempts at turning the fetus, and 174 (51%) succeeded. However, of the 174, 54 (31%) were delivered by cesarean section after a trial of labor. Reasons for this high rate were failure to progress in labor and failed induction of labor. A total of 26% of breech presentations were delivered by cesarean section without attempts to turn the fetus or a trial of labor.

Childbirth, Delivery (Childbirth)

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