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Revisiting the management of term breech presentation: a proposal for overcoming some of the controversies

BACKGROUND: The debate surrounding the management of term breech presentation has excessively focused on the mode of delivery. Indeed, a steady decline in the rate of vaginal breech delivery has been observed over the last three decades, and the soundness of the vaginal route was seriously challenge...

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Autores principales: Carbillon, Lionel, Benbara, Amelie, Tigaizin, Ahmed, Murtada, Rouba, Fermaut, Marion, Belmaghni, Fatma, Bricou, Alexandre, Boujenah, Jeremy
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7196223/
https://www.ncbi.nlm.nih.gov/pubmed/32359354
http://dx.doi.org/10.1186/s12884-020-2831-4
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author Carbillon, Lionel
Benbara, Amelie
Tigaizin, Ahmed
Murtada, Rouba
Fermaut, Marion
Belmaghni, Fatma
Bricou, Alexandre
Boujenah, Jeremy
author_facet Carbillon, Lionel
Benbara, Amelie
Tigaizin, Ahmed
Murtada, Rouba
Fermaut, Marion
Belmaghni, Fatma
Bricou, Alexandre
Boujenah, Jeremy
author_sort Carbillon, Lionel
collection PubMed
description BACKGROUND: The debate surrounding the management of term breech presentation has excessively focused on the mode of delivery. Indeed, a steady decline in the rate of vaginal breech delivery has been observed over the last three decades, and the soundness of the vaginal route was seriously challenged at the beginning of the 2000s. However, associations between adverse perinatal outcomes and antenatal risk factors have been observed in foetuses that remain in the breech presentation in late gestation, confirming older data and raising the question of the role of these antenatal risk factors in adverse perinatal outcomes. Thus, aspects beyond the mode of delivery must be considered regarding the awareness and adequate management of such situations in term breech pregnancies. MAIN BODY: In the context of the most recent meta-analysis and with the publication of large-scale epidemiologic studies from medical birth registries in countries that have not abruptly altered their criteria for individual decision-making regarding the breech delivery mode, the currently available data provide essential clues to understanding the underlying maternal-foetal conditions beyond the delivery mode that play a role in perinatal outcomes, such as foetal growth restriction and gestational diabetes mellitus. In view of such data, an accurate evaluation of these underlying conditions is necessary in cases of persistent term breech presentation. Timely breech detection, estimated foetal weight/growth curves and foetal/maternal well-being should be considered along with these possible antenatal risk factors; a thorough analysis of foetal presentation and an evaluation of the possible benefit of external cephalic version and pelvic adequacy in each specific situation of persistent breech presentation should be performed. CONCLUSION: The adequate management of term breech pregnancies requires screening and the efficient identification of breech presentation at 36 weeks of gestation, followed by thorough evaluations of foetal weight, growth and mobility, while obstetric history, antenatal gestational disorders and pelvis size/conformation are considered. The management plan, including external cephalic version and follow-up based on the maternal/foetal condition and potentially associated disorders, should be organized on a case-by-case basis by a skilled team after the woman is informed and helped to make a reasoned decision regarding delivery route.
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spelling pubmed-71962232020-05-08 Revisiting the management of term breech presentation: a proposal for overcoming some of the controversies Carbillon, Lionel Benbara, Amelie Tigaizin, Ahmed Murtada, Rouba Fermaut, Marion Belmaghni, Fatma Bricou, Alexandre Boujenah, Jeremy BMC Pregnancy Childbirth Debate BACKGROUND: The debate surrounding the management of term breech presentation has excessively focused on the mode of delivery. Indeed, a steady decline in the rate of vaginal breech delivery has been observed over the last three decades, and the soundness of the vaginal route was seriously challenged at the beginning of the 2000s. However, associations between adverse perinatal outcomes and antenatal risk factors have been observed in foetuses that remain in the breech presentation in late gestation, confirming older data and raising the question of the role of these antenatal risk factors in adverse perinatal outcomes. Thus, aspects beyond the mode of delivery must be considered regarding the awareness and adequate management of such situations in term breech pregnancies. MAIN BODY: In the context of the most recent meta-analysis and with the publication of large-scale epidemiologic studies from medical birth registries in countries that have not abruptly altered their criteria for individual decision-making regarding the breech delivery mode, the currently available data provide essential clues to understanding the underlying maternal-foetal conditions beyond the delivery mode that play a role in perinatal outcomes, such as foetal growth restriction and gestational diabetes mellitus. In view of such data, an accurate evaluation of these underlying conditions is necessary in cases of persistent term breech presentation. Timely breech detection, estimated foetal weight/growth curves and foetal/maternal well-being should be considered along with these possible antenatal risk factors; a thorough analysis of foetal presentation and an evaluation of the possible benefit of external cephalic version and pelvic adequacy in each specific situation of persistent breech presentation should be performed. CONCLUSION: The adequate management of term breech pregnancies requires screening and the efficient identification of breech presentation at 36 weeks of gestation, followed by thorough evaluations of foetal weight, growth and mobility, while obstetric history, antenatal gestational disorders and pelvis size/conformation are considered. The management plan, including external cephalic version and follow-up based on the maternal/foetal condition and potentially associated disorders, should be organized on a case-by-case basis by a skilled team after the woman is informed and helped to make a reasoned decision regarding delivery route. BioMed Central 2020-05-03 /pmc/articles/PMC7196223/ /pubmed/32359354 http://dx.doi.org/10.1186/s12884-020-2831-4 Text en © The Author(s). 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Debate
Carbillon, Lionel
Benbara, Amelie
Tigaizin, Ahmed
Murtada, Rouba
Fermaut, Marion
Belmaghni, Fatma
Bricou, Alexandre
Boujenah, Jeremy
Revisiting the management of term breech presentation: a proposal for overcoming some of the controversies
title Revisiting the management of term breech presentation: a proposal for overcoming some of the controversies
title_full Revisiting the management of term breech presentation: a proposal for overcoming some of the controversies
title_fullStr Revisiting the management of term breech presentation: a proposal for overcoming some of the controversies
title_full_unstemmed Revisiting the management of term breech presentation: a proposal for overcoming some of the controversies
title_short Revisiting the management of term breech presentation: a proposal for overcoming some of the controversies
title_sort revisiting the management of term breech presentation: a proposal for overcoming some of the controversies
topic Debate
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7196223/
https://www.ncbi.nlm.nih.gov/pubmed/32359354
http://dx.doi.org/10.1186/s12884-020-2831-4
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