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Practical insight into upright breech birth from birth videos: A structured analysis. | LitMetric

Practical insight into upright breech birth from birth videos: A structured analysis.

Birth

Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.

Published: June 2020

AI Article Synopsis

  • - The study analyzed 42 videos of successful upright vaginal breech births to identify features that promote positive outcomes and enhance teaching methods for breech deliveries.
  • - Results showed that only 33% of births were completely spontaneous, with a median time of 1:52 minutes between the birth of the fetal pelvis and head; specific maneuvers were utilized to address complications like fetal arm entrapment.
  • - The findings suggest that most upright breech births happen within 3 minutes of the fetal pelvis being born, leading to the introduction of a new physiological breech algorithm for teaching and practice.

Article Abstract

Background: We aimed to identify common features of upright vaginal breech births with good outcomes to refine a physiological approach to teaching breech birth.

Methods: We performed a structured analysis of 42 videos of successful upright breech births (eg, kneeling, hand/knees), facilitated by obstetricians (n = 34) and midwives (n = 8) in nine different countries. Precise timings and relevant clinical details were recorded on an Excel spreadsheet. Each video was analyzed twice by at least two members of the research team. Time-to-event intervals, frequencies of interventions, and descriptive statistics were calculated using SPSS.

Results: A completely spontaneous (labor mechanisms and maternal effort only) birth occurred in 14/42 (33%) cases. The median time between the birth of the fetal pelvis and the head in all births was 1:52 (IQR 1:05,2:46; min:sec). Lack of spontaneous rotation to a sacro-anterior position by the time the fetus had emerged to the nipple line was strongly associated with fetal arm entrapment. The following maneuvers were used: shoulder press to flex the aftercoming head in midpelvis or outlet (n = 24), sweeping down arm/s (n = 12), buttock lift to assist shoulder press (n = 6), modified Mauriceau (n = 6), rotational maneuvers to release an entrapped arm (n = 6), elevate and rotate fetal head to assist engagement (n = 2), and conversion into supine maternal position (n = 2).

Conclusions: Most upright breech births occur within 3 minutes of the birth of the fetal pelvis. Upright breech birth attendants use variations of traditional maneuvers. We introduce a physiological breech algorithm as an initial timekeeping framework for teaching, research, and practice.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7318698PMC
http://dx.doi.org/10.1111/birt.12480DOI Listing

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