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Is there any significance to this classification of the type of breech presentation?
Yes. If a vaginal delivery was being considered, the type of breech does influence the plan of action regarding the method of delivery, as we shall see shortly.
Breech delivery
What should be the method of delivery in breech presentation?
In the UK and most other western countries, since the end of the 1990s and more so since around the year 2000, for all singleton full-term babies, the recommended mode of delivery is a planned (elective) caesarean section.
This followed a study which showed that there is increased morbidity for newborns with breech vaginal delivery compared to planned caesarean delivery.
This is now established practice which is probably irreversible as doctors get increasingly de-skilled in the art of breech vaginal delivery.
However, this practice is by no means universal and there are many countries in the world where breech vaginal delivery is still offered as an option.
In those places where breech vaginal delivery is an option, what are the criteria for taking this route?
Each case needs to be thoroughly evaluated and a decision on the method of delivery made on its own merit.
There are many factors that will influence the decision, and each has to be considered individually before reaching a conclusion on the best way forward. These factors include:
This followed a study which showed that there is increased morbidity for newborns with breech vaginal delivery compared to planned caesarean delivery.
This is now established practice which is probably irreversible as doctors get increasingly de-skilled in the art of breech vaginal delivery.
However, this practice is by no means universal and there are many countries in the world where breech vaginal delivery is still offered as an option.
In those places where breech vaginal delivery is an option, what are the criteria for taking this route?
Each case needs to be thoroughly evaluated and a decision on the method of delivery made on its own merit.
There are many factors that will influence the decision, and each has to be considered individually before reaching a conclusion on the best way forward. These factors include:
Ø The previous obstetric history of the mother
Ø The presence or absence of uterine abnormalities or pelvic masses
Ø Presence of identified fetal abnormalities
Ø Gestation age
Ø Estimated fetal weight
Ø The position of the placenta in the womb
Ø Type of breech.
As everybody will appreciate, it is not a light or easy decision to make.
Why is previous obstetric history important in deciding the method of delivery?
If the expectant mother has had a caesarean section in the past, then this is considered to be reason enough to opt for a repeat caesarean section. A vaginal delivery is considered to be too risky in such a case.
Bear in mind that this is not an absolute indication for a caesarean delivery and, in exceptional circumstances, a vaginal breech delivery may be aimed for. The operative word here is "exceptional".
If she had a very difficult vaginal delivery in the past, again a caesarean section is recommended. On the other hand, if her previous deliveries had been smooth - and in the absence of any other, contraindicating factors - vaginal breech delivery might remain an option.
Bear in mind that this is not an absolute indication for a caesarean delivery and, in exceptional circumstances, a vaginal breech delivery may be aimed for. The operative word here is "exceptional".
If she had a very difficult vaginal delivery in the past, again a caesarean section is recommended. On the other hand, if her previous deliveries had been smooth - and in the absence of any other, contraindicating factors - vaginal breech delivery might remain an option.