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KMID : 0358419710140070003
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Korean Journal of Obstetrics and Gynecology
1971 Volume.14 No. 7 p.3 ~ p.9
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Breech Delivery
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姜信明/Kang, Shin Myung
全惠子/姜敏子/趙貞新/Chun, Hae Ja/Kang, Min Ja/Cho, Jjung Shin
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Abstract
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Management of the breech delivery is still a-difficult problem because there is no practical way of measurement of fetal biparietal diameter up 1o date, and fetal mortality remains still high. It seemed very important to evaluate the pelvic capacity and to juge the fetal size accurately by experienced obstetrician before the labor takes place in order to reduce the unnecessary fetal loss or hypoxia which affect second generations.
The data to be presented are based on 276 cases of breech presentation seen past 6 years between January 1963 and December 1968 in Ewha Woman´s University Hospital, Seoul, Korea.
The following results were obtained.
1. The incidence of breech delivery was one in every 38 cases or 2.5% of 10, 679 cases of total deliveries during past 6 years. In this study, breech presentation associated with twins and infant weighing under 1, 000gm were excluded.
2. Placenta previa is a most commonly associated etiologic factor(6 cases) in breech presentation in which the incidence is significantly high, 3 times the average one in this institute.
3. Operative delivery or Cesarean section was required in 19% of the total cases of breech presentation with 1, 000gm or more of the birth weight, and in. 24% of the cases of term breech presentation.
4. In cases of that anteroposterior diameter of pelvic inlet in 10cm or less, or interspinous diameter of mid-pelvis is 9.5cm or below, approximately one-half (48%) of the cases of breech presentation necessitated Cesarean section. 5. In general, the more big the infant´s birth weight the greater the incidence of Cesarean section required such as 28% done in the moderate sized infants (3.Okg---3.49kg), and 37% in the rather large infants weighing 3.5kg-´ 3.99kg in breech presentation.
6. In careful revewing the fetal *distress in vaginal breech delivery according to the birth weight, the frequency of infant with poor condition or lower Apgar Score of 6 or less were 19% of the cases among average term babies weighing 3.0kg. However in case of infant body weight exceeding 3.Okg, the hypoxic infant rate were significantly increased up to 61% of the case or 3 times the one with 3.0kg birth weight. Severe hypoxic infants with Apgar Score of 4 or less were apt. to occur in the footling presentaiton (68%), twice as much as that in complete breech presentation. No fetal fractures or dislocation and Erb´s paralysis were seen in this whole subject.
7. When dealing with breech vaginal delivery, over all 6 cases of more than average sizd infant wighing from 3.3kg to 3. 5kg or more were dead due to breech deli-very whe eas all alived among 132 cases of average size of infant weighing from 3.Okg-3.2kg. However, infants weighing 3. 3kg or more who were deliveried by Cesarean section were all alived.
In this whole series of breech presentation, no maternal deaih were seen except 3 cases of mild degree of cervical lacerations. .
8.The corrected perinatal mortality in the vaginal breech delivery was 9.3% among the premature. infants anti 4.1% among tlie.term babies.
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