Trends in vaginal breech delivery

Hehir, Mark P.

doi:10.1136/jech-2015-205592

Cited by 18 publications

(18 citation statements)

References 21 publications

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“…Increasing CS rate among women with breech presentation is a common phenomenon particularly since the publication of the term breech trial [33–35], and our hospital is not an exception. Groups 6 and 7 consist of women with breech presentation and showed high CS rates.…”

Section: Discussionmentioning

confidence: 99%

The Ten-Group Robson Classification: A Single Centre Approach Identifying Strategies to Optimise Caesarean Section Rates

Tanaka

Mahomed

2017

Obstetrics and Gynecology International

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Caesarean section (CS) rates have been increasing worldwide and have caused concerns. For meaningful comparisons to be made World Health Organization recommends the use of the Ten-Group Robson classification as the global standard for assessing CS rates. 2625 women who birthed over a 12-month period were analysed using this classification. Women with previous CS (group 5) comprised 10.9% of the overall 23.5% CS rate. Women with one previous CS who did not attempt VBAC contributed 5.3% of the overall 23.5% CS rate. Second largest contributor was singleton nulliparous women with cephalic presentation at term (5.1% of the total 23.5%). Induction of labour was associated with higher CS rate (groups 1 and 3) (24.5% versus 11.9% and 6.2% versus 2.6%, resp.). For postdates IOL we recommend a gatekeeper booking system to minimise these being performed <41 weeks. We suggest setting up dedicated VBAC clinic to support for women with one previous CS. Furthermore review of definition of failure to progress in labour not only may lower CS rates in groups 1 and 2a but also would reduce the size of group 5 in the future.

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Section: Discussionmentioning

confidence: 99%

The Ten-Group Robson Classification: A Single Centre Approach Identifying Strategies to Optimise Caesarean Section Rates

Tanaka

Mahomed

2017

Obstetrics and Gynecology International

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“…[24][25][26] Groups 6 and 7 consist of women with breech presentation and showed high CS rates. Despite the criticisms of the term breech trial, many hospitals including ours have been reluctant to offer vaginal breech birth.…”

Section: Overall Section Ratesmentioning

confidence: 99%

Use of the Robson classification to assess caesarean section trends in tertiary hospital

Gomathy

Kannan

Kondareddy

2018

Int J Reprod Contracept Obstet Gynecol

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The ten-group Robson classification has been praised for its simplicity, robustness, reproducibility, and flexibility 8 and has been recommended for both the monitoring ABSTRACT Background: With caesarean sections on the rise WHO proposes that health care facilities use the Robson's 10 group classification system to audit their C-sections rates. This classification would help understand the internal structure of the CS rates at individual health facilities identify key population groups, indications in each group and formulate strategies to reduce these rates. Methods: This was a cross sectional study for a period of 6 months at a tertiary care hospital in a rural area in Karnataka, South India. Women who delivered during this period were included and classified into 10 Robson's classes and percentages were calculated for the overall rate, the representation of groups, contribution of groups and Caesarean percentage in each group. Results: Highest contribution was by Group 5 and Group 2. Together these two groups contributed to 50.3% of the total Caesareans. Followed by Group 1 and 10. A Groups 6, 4, 8 and 9 by themselves did not contribute much but within their groups had a 100% C-section rate. Conclusions: Robson 10-group classification provides easy way in collecting information about Caesarean section rate which obtains good insight into certain birth groups. Reducing primary section rates, adequate counselling and encouraging for VBAC, changing the norms for non-reassuring fetal status, training and encouraging obstetricians to perform versions when not contraindicated could reduce the contribution of Robson's groups towards the absolute CSection rates.

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“…During the second stage of labor, a forward‐leaning kneeling position was adopted. After birth and descent of the fetal pelvis, the Specialist Midwife identified a lack of rotation of fetal sacrum to maternal pubes, as should be observed in the normal mechanism for physiological breech birth . This lack of rotation with further descent of the fetal torso, where the baby remains in a sacrum transverse position with the shoulders in the anteroposterior diameter, is associated with nuchal arm complications .…”

Section: Discussionmentioning

confidence: 99%

“…The Royal College of Obstetricians and Gynaecologists (RCOG) report the risk of perinatal mortality as 0.5/1000 with a planned cesarean birth, 1/1000 with a cephalic birth, and 2/1000 with a breech birth . Although the increase in absolute risk is small, avoidance of vaginal breech birth has led to a decline in skill level throughout the National Health Service (NHS) and other settings, and increased fetal and maternal risks in subsequent pregnancies . It has also prompted feelings of “stress, anger, fear, and injustice” among women who would prefer to plan a vaginal breech birth but cannot access the experienced support required…”

Section: Introductionmentioning

confidence: 99%

Face‐to‐pubes rotational maneuver for bilateral nuchal arms in a vaginal breech birth, resolved in an upright maternal position: A case report

Walker

Spillane

2020

Birth

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Background A physiological breech birth is one in which the woman is encouraged to remain active throughout her labor and able to assume the position of her choice for the birth. Use of this strategy within the United Kingdom National Health Service has led to the use of innovative maneuvers to relieve obstruction when women give birth in upright positions, for example, kneeling or standing. This includes use of the face‐to‐pubes rotational maneuver to relieve extended nuchal arm(s). In this paper, we report a case where the face‐to‐pubes rotational maneuver was used to relieve bilateral nuchal arm entrapment in a breech birth. Methods Single‐case study. We aimed to generate an in‐depth understanding of how this maneuver works and how professionals decide to use it by exploring its use in a real‐life context. Results The face‐to‐pubes rotational maneuver appears to be an effective method of relieving nuchal arm entrapment when used by experienced hands. In cases of bilateral nuchal arm entrapment, elevation to a higher station may be necessary to dis‐impact the arms above the pelvic inlet before the fetus can be rotated. After face‐to‐pubes rotation and release of arms, the head should be realigned in an occiput anterior position for delivery. Conclusion The face‐to‐pubes rotational maneuver can be taught for resolution of nuchal arms in an upright position. Parents should be informed of the availability or not of a specialist midwife trained in physiological breech birth, as this may be important to their decision‐making.

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Trends in vaginal breech delivery

Cited by 18 publications

References 21 publications

The Ten-Group Robson Classification: A Single Centre Approach Identifying Strategies to Optimise Caesarean Section Rates

The Ten-Group Robson Classification: A Single Centre Approach Identifying Strategies to Optimise Caesarean Section Rates

Use of the Robson classification to assess caesarean section trends in tertiary hospital

Face‐to‐pubes rotational maneuver for bilateral nuchal arms in a vaginal breech birth, resolved in an upright maternal position: A case report

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