SUMMARY: ACOG has released guidance that addresses the trend in the United States to deliver term singleton fetuses in breech presentation. If the presentation of a breech presentation is confirmed at term, a . the American College of Obstetricians and Gynecologists (ACOG) and the. The incidence of breech presentation decreases from about 20% at 28 weeks of asphyxia or trauma.1,2 Caesarean section for breech presentation has been.
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ACOG Committee Opinion No. 745: Mode of Term Singleton Breech Delivery.
Planned vaginal delivery of a term singleton breech fetus may be reasonable under hospital-specific protocol guidelines for eligibility and labor management. If any problems arise with you or the fetus, ECV will be stopped right away. If there is pressure put on the cord or it becomes pinched, it can decrease the flow of blood and oxygen through the cord to the baby. Finally, a planned vaginal delivery of a term singleton breech fetus may be reasonable under hospital-specific guidelines 12, External cephalic version ECV is an attempt to turn the fetus so that he or she is head down.
Outcomes of children at 2 years after planned cesarean birth versus planned vaginal birth for breech presentation at term: Cochrane Database of Systematic ReviewsIssue 4.
Women’s Health Care Physicians
The American College of Obstetricians and Gynecologists makes the following recommendations: There is a trend in the United States to perform cesarean delivery for term singleton fetuses in a breech presentation. In addition, the protocol presented by one report required documentation of fetal head flexion and adequate amniotic fluid volume, defined as a 3-cm vertical pocket With each cesarean delivery, these risks increase.
As the fetus grows bigger, there is less room for him or her to move. If this happens, ECV may be tried again.
It is not always known why a fetus is breech. The initial criteria used in these reports were similar: If a problem occurs, a cesarean delivery can be performed quickly, if necessary. No part of this publication may be reproduced, stored in a retrieval system, posted on the Internet, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.
A normal position assumed by a fetus in which the head is positioned down ready to be born first. ECV will not be tried if you are carrying more than one fetus, there are concerns about the health of the fetus, you have certain abnormalities of the reproductive system, or the placenta is in the wrong place or has detached from the wall of the uterus placental abruption.
External cephalic version for breech presentation at term. More than one half of attempts at ECV succeed. A tube-like structure surrounded by muscles leading from the uterus to the outside of the body.
Mode of term singleton breech delivery. Cesarean delivery will be the preferred mode of delivery for most physicians because of the diminishing expertise in vaginal breech delivery.
In the last weeks of pregnancy, fetuses usually move so that their heads are positioned to come out of the vagina first during birth. External cephalic version should be attempted only in settings in which cesarean delivery services are readily available. Two people may be needed to perform ECV. A test in which sound waves are used to examine internal structures. Both vaginal birth and cesarean birth carry certain risks when a fetus is breech.
ACOG Committee Opinion No. Mode of Term Singleton Breech Delivery.
Since that time, there have been additional publications that modify the original conclusions of the Ackg Breech Trial. The frequency of adverse events was not significantly different between groups receiving and not receiving regional anesthesia for external cephalic version This Committee Opinion is updated as highlighted to reflect a limited, focused change in the evidence regarding external cephalic version for breech presentation at term.
The decision regarding the mode of delivery should consider patient wishes and the experience of the health care provider. It can improve your chance of having a vaginal birth.
Mode of delivery and outcome of term singleton breech deliveries at a single center. The ACOG policies can be found on acog.
Planned vaginal delivery of a term singleton breech fetus may be reasonable under hospital-specific protocol guidelines for eligibility and labor management. Effect of regional anesthesia on the success rate presentaion external cephalic version: You usually need to meet certain guidelines specific to your hospital.