Motion: All Breech Babies Should Be Born By Elective Caesarean

Affirmative
Summary Of Key Points Term Breech Trial (TBT) - a self fulfilling prophecy Maternal and fetal risks (see RCOG and ACOG green top guidelines) Decreasing opportunities for training resulting in loss of skills and lack of confidence. TBT is not the only study mention er!st et al (S"eden# ($%%&#' (iet!erg et al ()etherlands a !ig study of &*+%%%# ($%%*#' Kre!s et al (Denmark# ($%%*#' ,il!ert et al (-alifornia# ($%%&# aternal an!iety Trauma of emergency.crash section. /lecti0e caesarean allo"s planning and reduces an1iety. Many planned 0aginal !irths end in emergency section. Conse"uences of #mergency section /lecti0e caesarean ha0e !etter outcomes than emergency caesarean Training is not a su$stitute for e!perience and does not e"uate to competence Training 2uality may 0ary !et"een institutions. Simulation training not sufficient+ is not true to real life 0aginal !reech. 3ack of confidence in !reech training 4ustralian study (-hinnock 5 (o!son $%%6# %ncreasing pre&alence of co-mor$idities 7ncreased o!esity (BM7 8&*# (ise in a0erage maternal age ((-O,+$%%9# aternal ris's of &aginal $reech (isks of inter0entions to "omen "ith 0aginal !reech+ such as episiotomy+ forceps+ stress+ symphysiotomy :oman;s e1perience negati0e staff "ill !e keen to "atch+ resulting in o0ercro"ding in the deli0ery room+ contri!uting to increased stress and an1iety. (isks of inter0entions to "omen "ith 0aginal !reech+ such as episiotomy+ forceps+ stress+ symphysiotomy (etal ris's of &aginal $reech 1

<m!ilical cord compression+ fetal hypo1ia+ acidemia and cord prolapse (=amamura et al+ $%%6# Palsies and fetal trauma due to delayed deli0ery of the !ody (eferences 4-O,+ $%%>. Mode of Term Singleton Breech Deli0ery. 4-O, -ommittee Opinion )o &9%. 4merican -ollege of O!stetricians and ,ynecologists. O!stetric ,ynecology+ ?%@+ pp.$&*A6 4lara! M.+ (egan -.+ O;-onnell M.P.+ Keane D.P.+ O; erlihy -. 5 Boley M./.+ $%%9. Singleton 0aginal !reech deli0ery at termC still a safe option. O!stetrics and ,ynecology ?%&+9%69?$. 4lshaheen 5 4!d 4lAKarim.+ $%?%. Perinatal outcomes of singleton term !reech deli0eries in Basra. /astern Mediterranean ealth Dournal. ?>(?#C&9AE 4ndreasen et al)* $%?%. Deli0ery of a !reech presentation. Tidsskrift for Den )orske 3aegeforening. ?&%(>#C>%*A@ 4tis et al)* $%??. 4pgar scores in assessing mor!idity of the second neonate of cephalic.nonAcephalic t"ins in different deli0ery modes. Dournal of O!stetrics 5 ,ynaecology. &?(?#C9&A6+ -arcopino F.+ ShoGai (.+ D;/rcole -. 5 Bou!li 3. $%%6. Brench trainees in o!stetrics and gynaecology theoretical training and practice of 0aginal !reech deli0eryC a national sur0ey. /uropean Dournal of O!stetrics+ ,ynecology and (eproducti0e Biology ?&*+?6A$%. -hinnock M.+ (o!son S.+ $%%6. O!stetric Trainees; /1perience in Haginal Breech Deli0ery 7mplications for Buture Practice. O!stetrics and ,ynaecology ??%+ E%%AE%&. -hinnock+ M.+ (o!son+ S.+ $%%6. O!stetrician Training in Breech Deli0ery. O!stetric ,ynecology. HO3. ??%+ )O. 9 -oyle M/+ Smith -4+ Peat B' -ephalic 0ersion !y mo1i!ustion for !reech presentation.' -ochrane Data!ase Syst (e0. $%%* 4pr ?@'($# -ochrane -olla!oration+ $%??.Planned caesarean section for term !reech deli0ery ((e0ie"# ii Da0iss et al)* $%?%. /0ol0ing e0idence since the term !reech trialC -anadian response+ /uropean dissent and potential solutions. Dournal of o!stetrics 5 gynaecology -anadaC DO,-. &$ (&# $?6A$9 Demirci et al)* $%?$. Pregnancy outcomes !y mode of deli0ery among !reech !irths. 4rchi0es of ,ynecology 5 O!stetrics. $@*($#C$E6A&%&+ Deutsch et al)* $%??.-esarean deli0ery 0ersus 0aginal deli0eryC impact on sur0i0al and mor!idity for the !reech fetus at the threshold of 0ia!ility. Dournal of MaternalABetal 5 )eonatal Medicine. $9(*#C6?&A6 De0araGan et al)* $%??. 4ttitudes among Toronto o!stetricians to"ards 0aginal !reech deli0ery. Dournal of o!stetrics 5 gynaecology -anadaC DO,-. &&(*#C9&6A9$ Bischer (.+ $%%E. Breech presentation' eMedicine. photographic illustrations of 0aginal !reech deli0ery ,arcia et al)* $%%$. 3ong !one fractures in e1treme lo" !irth "eight infants at !irthC o!stetrical considerations. Puerto (ico ealth Sciences Dournal. $?(&#C$*&A*

,leIerman M' Bi0e years to the term !reech trialC the rise and fall of a randomiIed controlled trial.' 4m D O!stet ,ynecol. $%%> Dan'?E9(?#C$%A* ,uittier et al)* $%??. Breech presentation and choice of mode of child!irthC a 2ualitati0e study of "omen;s e1periences. Mid"ifery. $6(>#C pp. $%@A?& annah+ M./.+ annah+ :. D.+ e"son+ S. 4.+ odnett+ /. D.+ Saigal+ S.+ :illan+ 4. (.+ $%%%. Planned caesarean section 0ersus planned 0aginal !irth for !reech presentation at termC a randomised multicentre trial. The 3ancet+ $*>+ pp. ?&6*A?&@& arder et al)* $%%$. ,ermanAspeaking mid"i0es prefer 0aginal mode of deli0ery to electi0e caesarean. Jeitschrift fur ,e!urtshilfe und )eonatologies. $%> ($#C 6$A9 artnack+ T.+ et al.+ $%??. -onse2uences of the Term Breech Trial in Denmark. 4cta O!stetricia et ,ynecologica Scandina0ica. E%(6#C6>6A6? er!st and Kallen+ $%%@. 7nfluence of mode of deli0ery on neonatal mortality in the second t"in+ at and !efore term. BDO,C 4n 7nternational Dournal of O!stetrics 5 ,ynaecology. ??*(?$#C?*?$A6 odnett et al)* $%%*. Mother;s 0ie"s of their child!irth e1pereicnes $ years after planned -aesarean 0ersus planned 0aginal !irth for !reech presentation at term+ in the international randomiIed Term Breech Trial. Dournal of O!stetrics 5 ,ynaecology -anadaC DO,-. $6 (&#C $$9A&? ofmeyr ,D+ annah M/' Planned caesarean section for term !reech deli0ery. -ochrane Data!ase Syst (e0. $%%&'(&# ofmeyr ,D' 7nter0entions to help e1ternal cephalic 0ersion for !reech presentation at term. -ochrane Data!ase Syst (e0. $%%9'(?# ofmeyr ,D+ Kulier (' -ephalic 0ersion !y postural management for !reech presentation.' -ochrane Data!ase Syst (e0. $%%%'(&# Denis 4' Pregnancy+ Breech deli0ery. eMedicine+ $%%>. Bundamentals of O!stetrics and ,ynaecology 6th /dition. 3le"ellynADones D. Mos!y ?EEE Kalogiannidis et al)* $%?%. Pre0ious cesarean section increases the risk for !reech presentation at term pregnancy. -linical 5 /1perimental O!stetrics 5 ,ynecology. &6(?#C$EA&$ Kok et al)* $%%@. /1pectant parentsK preferences for mode of deli0ery and tradeAoffs of outcomes for !reech presentation. Patient /ducation 5 -ounseling. 6$($#C&%*A?% Kotaska 4+ $%%9. 7nappropriate use of randomised trials to e0aluate comple1 phenomenaC case study of 0aginal !reech deli0ery.' BMD. Oct &%'&$E(696&#C?%&EA9$. Kotaska et al)* $%%E. SO,- clinical practice guidelineC Haginal deli0ery of !reech presentationC no. $$>+ 7nternational Dournal of ,ynaecology 5 O!stetrics. ?%6($#C?>EA6> Kotaska+ 4.+ Menticoglou+ S.+ ,agnon+ (.+ $%%E. Haginal Deli0ery of Breech Presentation. SO,-linical Practice ,uideline+ $$>+ pp. **6A*>> 3agrange et al)* $%%6. Breech presentation and 0aginal deli0eryC e0olution of accepta!ility !y o!stetricians and patients. ,ynecologie+ O!stetri2ue 5 Bertilite. &* (E#C 6*6A>& 3a0in et al)* $%%%. Teaching 0aginal !reech deli0ery and e1ternal cephalic 0ersion. 4 sur0ey of faculty attitudes. Dournal of (eproducti0e Medicine. 9* (?%#C @%@A?$ 3

3a"son+ ,. :.+ $%?$. The Term Breech Trial Ten =ears OnC Primum )on )ocereL Birth+ &E(?#+ pp. &AE 3ee -+ /lASayed ==+ ,ould DB+ $%%@. Population trends in cesarean deli0ery for !reech presentation in the <nited States+ ?EE6A$%%&. 4m D O!stet ,ynecol. $%%@ Dul'?EE(?#C*E.e?A@ 3eung et al)* $%%%. 4 sur0ey of pregnant "omen;s attitude to"ards !reech deli0ery and e1ternal cephalic 0ersion. 4ustralian 5 )e" Jealand Dournal of O!stetrics 5 ,ynaecology. 9% (&#C$*&AE 3udford et al)* $%?$. Pregnancy outcomes for nulliparous "omen of ad0anced maternal age in South 4ustralia+ ?EE@A$%%@. 4ustralian 5 )e" Jealand Dournal of O!stetrics 5 ,ynaecology. *$(&#C$&*A9? Molken!oer DB+ De!ie S+ (oumen BD+ et al' Maternal health outcomes t"o years after term !reech deli0ery. D Matern Betal )eonatal Med. $%%6 4pr'$%(9#C&?EA$9. Molken!oer et al)* $%%@. Mothers; 0ie"s of their child!irth e1perience t"o years after term !reech deli0ery. Dournal of Psychosomatic O!stetrics 5 ,ynaecology. $E (?#C &EA99 )assar )+ (o!erts -3+ Barratt 4+ et al' Systematic re0ie" of ad0erse outcomes of e1ternal cephalic 0ersion and persisting !reech presentation at term.' Paediatr Perinat /pidemiol. $%%> Mar'$%($#C?>&A 6?. Ma!stractN )ordt0eit T7+ Mel0e KK+ 4l!rechtsen S+ et al' Maternal and paternal contri!ution to intergenerational recurrence of !reech deli0eryC population !ased cohort study. BMD. $%%@ 4pr ?E'&&>(6>9E#C@6$A>. /pu! $%%@ Mar $6. Ma!stractN Pasupathy et al)* $%%E. Time trend in the risk of deli0eryArelated perinatal and neonatal death associated "ith !reech presentation at term. 7nternational Dournal of /pidemiology. &@($#C9E%A@ Pasupathy D+ :ood 4M+ Pell DP+ et al+ $%%@. Time trend in the risk of deli0eryArelated perinatal and neonatal death associated "ith !reech presentation at term. 7nt D /pidemiol. $%%E 4pr'&@($#C9E%A@. Pradhana+ P.+ MohaGer+ M.+ Deshpande+ S.+ $%%*. Outcome of term !reech !irthsC ?%Ayear e1perience at a district general hospital. BDO,C an 7nternational Dournal of O!stetrics and ,ynaecology+ Hol. ??$+ pp. $?@$$$ (ayl D+ ,i!son PD+ ickok D/' 4 populationA!ased caseAcontrol study of risk factors for !reech presentation.' 4m D O!stet ,ynecol. ?EE> Dan'?69(? Pt ?#C$@A&$. (iet!erg+ -.+ /lferinkAStinkens+ P.+ Hisser+ ,.+ $%%*. The effect of the Term Breech Trial on medical inter0ention !eha0iour and neonatal outcome in The )etherlandsC an analysis of &*+9*& term !reech infants. BDO,+ 0ol. ??$C $%* $%E (o!ilio et al)* $%%6. Haginal 0s. cesarean deli0ery for preterm !reech presentation of singleton infants in -aliforniaC a populationA!ased study. Dournal of (eproducti0e Medicine. *$(>#C96&AE+ (o!son S.+ (amsay B. 5 -handler K.+ ?EEE. (egistrar e1perience in 0aginal !reech deli0ery. o" much is occurringL 4ustralian and )e" Jealand Dournal of O!stetrics and ,ynaecology &E+$?*$?6. (oyal -ollege of O!stetricians and ,ynaecologists+ $%%>. The management of !reech presentation+ (oyal -ollege of O!stetricians and ,ynaecologists+ $%%>. /1ternal cephalic 0ersion and reducing the incidence of !reech presentation+

Sharma D.+ )e"man M.+ Boutchier D. 5 :illiams 4.+ ?EE6. )ational audit of the practice and training in !reech deli0eries in the <nited Kingdom. 7nternational Dournal of ,ynecology and O!stetrics *E+?%&?%@. Statistical Bulletin for Births and deaths in /ngland and :ales $%%@+ Office for )ational Statistics httpC..""".statistics.go0.uk.stat!ase.Product.aspL0lnkO?99%@. Stohl et al)* $%??.Haginal !reech deli0ery in 0ery lo" !irth "eight (H3B:# neonatesC e1perience of a single center. Dournal of Perinatal Medicine. &E(9#C&6EA@& Su+ M.+ :alter+ D. .+ :illan+ 4.+ (oss+ S.+ annah M. /.+ $%%9. Planned caesarean section decreases the risk of ad0erse perinatal outcome due to !oth la!our and deli0ery complications in the Term Breech Trial. BDO,C an 7nternational Dournal of O!stetrics and ,ynaecology. Hol. ???+ pp. ?%>*?%69 Su+ M.+ Mc3eod+ 3.+ (oss+ S.+ :illan+ 4.+ annah+ :. D.+ utton+ /.+ e"son+ S.+ annah+ M. /.+ $%%&. Bactors associated "ith ad0erse perinatal outcome in the Term Breech Trial. 4merican Dournal of O!stetrics and ,ynecology. ?@E(&#+ pp. 69%A* :hyte + annah M/+ Saigal S+ et al' Outcomes of children at $ years after planned cesarean !irth 0ersus planned 0aginal !irth for !reech presentation at termC the 7nternational (andomiIed Term Breech Trial. 4m D O!stet ,ynecol. $%%9 Sep'?E?(&#C@>9A6?. =amamuro+ =.+ (amin+ K D.+ (amin+ S. M.+ $%%6. Trial of Haginal Breech Deli0ery. -linical O!stetrics and ,ynaecology+ Hol. *%C $+ page *$>A*&> =u -. Teoh T. 5 (o!inson S. O!esity in Pregnancy. British Dournal of O!stetrics and ,ynaecology Hol ??& 7ssue ?% pp ???6A??$*. Jiadeh et al)* ?EE6. Preterm singleton !reech in )orth DordanC 0aginal 0ersus a!dominal deli0ery. ,ynecologic 5 O!stetric 7n0estigation. 99(&#C?>EA6$ )o authors listed' -linical practice guidelineC early detection of de0elopmental dysplasia of the hip. -ommittee on Puality 7mpro0ement+ Su!committee on De0elopmental Dysplasia of the ip. 4merican 4cademy of Pediatrics.' Pediatrics. $%%% 4pr'?%*(9 Pt ?#C@E>AE%*