Breech presentation: evolution of management

Manindra K Ghosh
Journal of Reproductive Medicine 2005, 50 (2): 108-16
From the historical perspective, vaginal delivery of the persistent breech presentation had been the tradition since the 1st century A.D. The external cephalic version was perfected and popularized in the mid-16th century. A variety of instruments and maneuvers had been used in the 19th century, with successful application of forceps to the after-coming head, and in 1924, Edmund Piper developed forceps for application only to the after-coming head. Vaginal delivery of breech cases had been performed primarily for the safety of the mother. As blood banking, antibiotics and safe anesthesia became available and legal and the ethical and social milieu was changing, cesarean breech deliveries were performed more liberally to reduce the increased perinatal morbidity and mortality of infants born of vaginal breech deliveries. Liberalization of cesarean delivery resulted in increased maternal mortality, and increased maternal morbidity created potential hazards in subsequent pregnancies. Renewed interest in revival of the practice of external cephalic version created successful reduction in term breech presentation. Several retrospective, prospective and randomized studies of vaginal deliveries of some types of breech cases were conducted under strict, selective protocols, with results of outcome comparable to those of cesarean sections. The International Term Breech Collaborative Group, after study of a large number of frank and complete breech cases, concluded that planned cesarean delivery is a "substantially better method of delivery for the fetus" and that a policy of planned vaginal birth for term, singleton, breech fetuses should no longer be encouraged.

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