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Review: Breech presentation: The controversy continues
Abstract
The management of a breech presentation has and will always be a controversial topic. In this review article we discuss the classification of breech presentations and the associated risks. We review the recent literature regarding the management options which include awaiting a spontaneous version, performing an external cephalic version (ECV) and the options to facilitate a successful version. We discuss the role of elective caesarean section (CS) versus vaginal delivery with regard to recent literature.
We conclude that ECV should be offered to all women with a breech presentation who do not have contraindications as it is effective and safe and that an ECV should be performed using a betamimetic for tocolysis. If an ECV is unsuccessful then the route of delivery for a persistent breech presentation should be individualised. Women with a breech presentation should be extensively counselled about the different delivery options and they should be provided with all the evidence, including the limitations of the evidence. The risks associated with caesarean section including the risk to future pregnancies must be emphasised as this enables a women to make an informed decision about their delivery. Vaginal delivery for certain selected breech presentations is still a good option. For women with a baby with flexed thighs who progress appropriately in labour with descent and spontaneous birth of the breech, the likelihood of difficulty with the delivery is very small. If progress is not good, even at full cervical dilation, recourse to CS is a safer option than attempts at breech extraction. Training videos are available in the World Health Organization Reproductive Health Library on the delivery of a breech presentation and on the technique of ECV (http://apps.who.int/rhl/videos/en/index.html).
We conclude that ECV should be offered to all women with a breech presentation who do not have contraindications as it is effective and safe and that an ECV should be performed using a betamimetic for tocolysis. If an ECV is unsuccessful then the route of delivery for a persistent breech presentation should be individualised. Women with a breech presentation should be extensively counselled about the different delivery options and they should be provided with all the evidence, including the limitations of the evidence. The risks associated with caesarean section including the risk to future pregnancies must be emphasised as this enables a women to make an informed decision about their delivery. Vaginal delivery for certain selected breech presentations is still a good option. For women with a baby with flexed thighs who progress appropriately in labour with descent and spontaneous birth of the breech, the likelihood of difficulty with the delivery is very small. If progress is not good, even at full cervical dilation, recourse to CS is a safer option than attempts at breech extraction. Training videos are available in the World Health Organization Reproductive Health Library on the delivery of a breech presentation and on the technique of ECV (http://apps.who.int/rhl/videos/en/index.html).
