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External cephalic version at term should be considered
EDITOR,--P J Danielian and colleagues report a 20% rate of long term disability among fetuses delivered by the breech, irrespective of mode of delivery.1 This raises the key issue of whether there is an inherent abnormality associated with such fetuses. Braun et al initially suggested that fetuses with a wide range of morphological and functional damage more commonly present by the breech.2 Hyten postulated that neurological deficit in the fetus disrupts normal muscular control, allowing for persistent extension of the legs and preventing the assumption of a normal fetal attitude.3
If it is presentation by the breech in utero or at delivery that puts the infant at greater risk of long term morbidity then external cephalic version at term might be considered. The literature suggests that this has a 65% success rate and significantly reduces the caesarean section rate (37%, compared with 83% in controls).4 The procedure is also cost
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- Long term outcome by method of delivery of fetuses in breech presentation at term: population based follow up
- P J Danielian, J Wang, and M H Hall
BMJ 1996 312: 1451-1453.[Abstract] [Full Text]
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