It is no secret that vaginal breech birth can be dangerous; but can it be safe? Published in 2000, the Term Breech Trial suggested that cesarean section is markedly safer for all term breech fetuses in all clinical settings. It has led to a dramatic decrease in rates of vaginal breech birth and a reduction in the obstetrical skill set needed to attend them. Increased maternal morbidity and maternal deaths from unnecessary cesareans are now being observed.
Unfortunately the Term Breech Trial protocol did not include adequate measures in the selection, intrapartum management and delivery technique to ensure safety. Larger trials with stricter safety measures have demonstrated that with a cautious protocol, breech birth can be conducted safely in appropriately supported obstetrical units. What are the important selection criteria, intrapartum management measures, and delivery techniques needed to ensure safety with vaginal breech birth?
Dr. Kotaska will outline the safety deficits of the Term Breech Trial and contrast them to the practice of obstetrical units that have successfully demonstrated safe breech birth. Together with participants he will explore our understanding of the physiology of breech birth, identify key components that can compromise safety, and outline clinical measures to avoid or rectify them.
Learning Objectives:
Objective 1: Outline the physiological differences between breech and cephalic birth and their implications for safety.
Objective 2: List the appropriate selection and intrapartum management criteria for safe vaginal breech birth.
Objective 3: List techniques to deal with complications of vaginal breech delivery.
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