exudates and Breech-Presentation

To evaluate oral nifedipine versus subcutaneous terbutaline tocolysis for external cephalic version (ECV).. A double-blind randomised trial.. A university hospital in Malaysia.. Non-labouring women with a term singleton fetus in breech presentation or transverse lie suitable for elective ECV.. Participants were randomised to either 10 mg oral nifedipine tablet and subcutaneous saline placebo or oral placebo tablet and 250 microgram bolus terbutaline subcutaneously. Participants and providers were blinded. Ultrasound assessment and cardiotocogram were performed prior to ECV. ECV was commenced 20-30 minutes after treatment. A maximum of two ECV attempts were permitted. Elective caesarean delivery or a repeat ECV attempt at a later date was offered to participants following failed ECV. After successful ECV, management was expectant.. Primary outcomes were successful ECV (cephalic presentation immediately after ECV) and caesarean delivery.. Ninety women were randomised: 44 to nifedipine and 46 to terbutaline. Initial ECV success rate was 15/44 (34.1%) versus 24/46 (52.2%) (relative risk [RR] 0.7, 95% CI 0.4-1.1; P= 0.094), and caesarean delivery rate was 34/44 (77.3%) versus 26/46 (56.5%) (RR 1.4, 95% CI 1.01-1.85; numbers needed to treat to benefit 5, 95% CI 2.5-55; P= 0.046) for nifedipine and terbutaline groups, respectively. Neonatal outcome was not different.. Bolus subcutaneous terbutaline tocolysis for ECV compared with oral nifedipine resulted in less caesarean deliveries. ECV success rate was not significantly higher. Larger studies are indicated.

Topics: Administration, Oral; Adult; Breech Presentation; Cesarean Section; Chemotherapy, Adjuvant; Double-Blind Method; Female; Humans; Malaysia; Nifedipine; Pregnancy; Terbutaline; Tocolysis; Tocolytic Agents; Version, Fetal

The 'Term Breech Trial' (TBT) results of 2001 have impacted on the mode of delivery of breech with a low threshold for caesarean delivery (CD) worldwide.. The trends in mode of delivery in developing countries have also changed. The aims of this retrospective analysis of all breech presentation was to see if similar trends are seen in Ipoh Hospital in Malaysia and if perinatal outcome is affected by mode of delivery.. All breech pregnancies presenting in the labour at the Ipoh Hospital, Malaysia, irrespective of gestation or booking status were analysed with respect to mode of delivery, fetal outcome and maternal mortality.. Out of 4886 breech presentation between 1992 and 2004, 3725 cases were evaluable. The prevalence of breech at birth was 3%. Vaginal breech deliveries decreased from 70.4% in 1994 to 13.1% in 2004. Consequently, CDs rose to 86.9% in CDs. There were 107 perinatal deaths (1994-2004) in the series and the crude perinatal mortality rate (PNMR) was four times higher than the hospital PNMR (11.4/1000 in 2004).. Although the CD rates rose exponentially with the release of the 'TBT', the mode of delivery did not impact on better PNMR in breech cases in this hospital. The need for selective vaginal births for breech, increased use of external cephalic version and the long implications of a uterine scar in future pregnancies in the 'shared antenatal care in the local context in a developing country is discussed.

Topics: Breech Presentation; Cesarean Section; Delivery, Obstetric; Developing Countries; Female; Humans; Malaysia; Perinatal Mortality; Pregnancy; Retrospective Studies

A prospective study was carried out on 26,176 Malaysian neonates born in the Maternity Hospital, Kuala Lumpur over a 12-month period to determine the incidence and associated risk factors of brachial plexus injuries. This condition was found in 42/26,176 neonates (1.6 per 1000 livebirths). Multiple logistic regression analysis of affected and control neonates from a nested case-control study showed that increasing birth weights and breech deliveries were the significant risk factors. Our study suggests that to reduce the occurrence of this condition, there is a need for: (i) better assessment of fetal size and maternal pelvimetry to enable earlier diagnosis of cephalo-pelvic disproportion, and (ii) review of the indications and techniques of breech delivery.

Topics: Birth Injuries; Birth Weight; Brachial Plexus; Breech Presentation; Female; Hospitals, Maternity; Humans; Incidence; Infant, Newborn; Logistic Models; Malaysia; Male; Pregnancy; Prospective Studies; Risk Factors