No More ‘Hands off the Breech’

Walker, Shawn W.

doi:10.55975/ypkw4847

Cited by 2 publications

(3 citation statements)

References 9 publications

(13 reference statements)

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“…There is also evidence for facilitated birth with the mother positioned on hands and knees, though this may be limited by staffing comfort and location [ 11 ]. Initiate the delivery with the Pinard maneuver delivering both lower extremities by inserting two fingers into the vagina and “hooking” the leg medially to laterally just above the knee [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…The baby is allowed to “hang” keeping the baby warm with a blanket and protecting the umbilical cord. At times, the baby may need help with positioning and new research shows assistance may be needed to guide the baby into position [ 11 ]. Once the nape of the neck is visible, the baby is delivered by holding the baby’s feet, easing the chin out by grasping with two fingers, and performing a sweeping motion to deliver once the chin has presented (Figures 10 - 12 ) [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

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Footling Breech Delivery in an Emergency Department Without Obstetrical Services: A Case Report

Bragg,

Bragg

2024

Cureus

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Hospitals without formal obstetric services place the emergency physician in the position of managing potentially complicated precipitous labor and delivery such as breech presentations. Breech deliveries pose an increased risk of significant morbidity and mortality to both the mother and fetus. Recent emphasis on cesarean section as the optimal delivery method for breech presentation has decreased education and comfort levels with breech vaginal deliveries. This case study highlights a patient who presented to a suburban emergency department (ED) in active labor with a footling breech presentation. No obstetrical services were available. The delivery was successful, and the neonate was resuscitated. Though emergency medicine residents receive training in standard vaginal deliveries, most residents do not receive firsthand experience with difficult deliveries. This case highlights the need for policy and procedure and annual competency training for physicians and allied staff in ED facilities without obstetrical services. Structured protocols and annual simulation training will improve outcomes for imminent deliveries with potential complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Footling Breech Delivery in an Emergency Department Without Obstetrical Services: A Case Report

Bragg,

Bragg

2024

Cureus

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“…The OptiBreech Algorithm aims to reduce the leading cause of breech birth-related injury: asphyxia [8][9][10] . Our team has raised concerns previously that current guidelines are not optimally safe 10,35 . Historically, breech practice has not been based on evidence, particularly around the expected time intervals as the breech baby emerges 8 .…”

Section: Discussionmentioning

confidence: 99%

How safe is it to plan a vaginal breech birth with OptiBreech collaborative care?: analysis of cumulative data within the OptiBreech Multiple Trials Cohort

Walker,

Das,

Stringer

et al. 2023

NIHR Open Res

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Background OptiBreech collaborative care is a multi-disciplinary care pathway for breech presentation at term. The OptiBreech Multiple Trial Cohort is designed to host multiple trials related to care for breech presentation. This design enables prospective data collection for a large cohort of women planning a vaginal breech birth (VBB), to assess rare safety outcomes, while answering questions requiring a smaller, randomised sample nested within this cohort. Methods OptiBreech database currently contains participants recruited from 10 January 2022, including 67 women randomised to either OptiBreech care or standard care, and 116 women who received OptiBreech care and were not randomised. Primary outcomes included vaginal birth rate, composite neonatal morbidity and mortality and composite maternal neonatal morbidity and mortality. Descriptive statistics for the entire cohort were analysed in SPSS Version 29. Sub-group analyses were identified through participant involvement and engagement work as important to support informed decision-making. Results Of 97 women who planned a VBB at any point, 44 (45.4%) achieved a vaginal birth, compared to 29/77 (37.7%) of women who did not plan a VBB. Admission rates to a neonatal unit were similar, 4/97 (4.1%) versus 3/77 (3.9%). In this cohort, there was no severe neonatal morbidity following planned VBB, compared to 3/77 (3.9%) among the cohort who did not plan a vaginal breech birth and 2/52 (3.7%) among women who planned a cephalic birth. Severe maternal morbidity following planned VBB was 7/89 (7.9%), compared to 9/76 (11.8%) for women who did not plan a VBB and 8/54 (14.8%) for women who planned a cephalic birth. Conclusions Planning a VBB with OptiBreech collaborative care has thus far been as safe as not planning a VBB. Detecting differences in rare outcomes will require thousands of births. Outcomes will continue to be monitored and reported here as the cohort grows.

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No More ‘Hands off the Breech’

Cited by 2 publications

References 9 publications

Footling Breech Delivery in an Emergency Department Without Obstetrical Services: A Case Report

Footling Breech Delivery in an Emergency Department Without Obstetrical Services: A Case Report

How safe is it to plan a vaginal breech birth with OptiBreech collaborative care?: analysis of cumulative data within the OptiBreech Multiple Trials Cohort

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