Any non-cephalic presentation in a fetus is regarded as malpresentation.The most common malpresentation,breech,contributes to 3%-5%of term pregnancies and is a leading indication for cesarean delivery.Identification o...Any non-cephalic presentation in a fetus is regarded as malpresentation.The most common malpresentation,breech,contributes to 3%-5%of term pregnancies and is a leading indication for cesarean delivery.Identification of risk factors and a proper physical examination are beneficial;however,ultrasound is the gold standard for the diagnosis of malpresentations.External cephalic version(ECV)refers to a procedure aimed to convert a non-cephalic presenting fetus to cephalic presentation.This procedure is performed manually through the mother’s abdomen by a trained health care provider,to reduce the likelihood of a cesarean section.Studies have reported a version success rate of above 50%by ECV.The main objective of this review is to present a broad perspective on fetal malpresentation,ECV,and delivery of a breech fetus.The focus is to elaborate all clinical scenarios of breech and to provide an evidence-based clinical approach for them.After discussing breech prevalence,risk factors,diagnosis,and management,an updated review of ECV is presented.Moreover,ECV indications/contraindications,alternatives,clinical techniques on how to perform ECV and breech vaginal delivery,and obstetrical considerations for the delivery of malpresentations are thoroughly discussed.展开更多
The care of obstetrics patients has improved dramatically over the past few decades.Unfortunately,rates of cesarean section remain high,and decreasing this rate requires close care and follow-up in the prenatal outpat...The care of obstetrics patients has improved dramatically over the past few decades.Unfortunately,rates of cesarean section remain high,and decreasing this rate requires close care and follow-up in the prenatal outpatient setting.Counseling regarding cesarean delivery and vaginal delivery is imperative.Opportunities still exist in helping patients objectively weigh the decision for cesarean delivery versus vaginal delivery.Additional developments have occurred in the intrapartum and the postpartum setting,with an aim to improve patient and neonatal outcomes.Changes have been implemented for patients undergoing cesarean delivery including preoperative and intraoperative treatment of pain,nausea,and vomiting,as well as postoperative care bundles that improve patient outcomes.Innovations have also occurred in the care of postpartum patients after vaginal delivery,again with improvements in patient outcomes.This article summarizes the current evidence,provides care recommendations,and identifies the next steps in improving obstetrics care.展开更多
文摘Any non-cephalic presentation in a fetus is regarded as malpresentation.The most common malpresentation,breech,contributes to 3%-5%of term pregnancies and is a leading indication for cesarean delivery.Identification of risk factors and a proper physical examination are beneficial;however,ultrasound is the gold standard for the diagnosis of malpresentations.External cephalic version(ECV)refers to a procedure aimed to convert a non-cephalic presenting fetus to cephalic presentation.This procedure is performed manually through the mother’s abdomen by a trained health care provider,to reduce the likelihood of a cesarean section.Studies have reported a version success rate of above 50%by ECV.The main objective of this review is to present a broad perspective on fetal malpresentation,ECV,and delivery of a breech fetus.The focus is to elaborate all clinical scenarios of breech and to provide an evidence-based clinical approach for them.After discussing breech prevalence,risk factors,diagnosis,and management,an updated review of ECV is presented.Moreover,ECV indications/contraindications,alternatives,clinical techniques on how to perform ECV and breech vaginal delivery,and obstetrical considerations for the delivery of malpresentations are thoroughly discussed.
文摘The care of obstetrics patients has improved dramatically over the past few decades.Unfortunately,rates of cesarean section remain high,and decreasing this rate requires close care and follow-up in the prenatal outpatient setting.Counseling regarding cesarean delivery and vaginal delivery is imperative.Opportunities still exist in helping patients objectively weigh the decision for cesarean delivery versus vaginal delivery.Additional developments have occurred in the intrapartum and the postpartum setting,with an aim to improve patient and neonatal outcomes.Changes have been implemented for patients undergoing cesarean delivery including preoperative and intraoperative treatment of pain,nausea,and vomiting,as well as postoperative care bundles that improve patient outcomes.Innovations have also occurred in the care of postpartum patients after vaginal delivery,again with improvements in patient outcomes.This article summarizes the current evidence,provides care recommendations,and identifies the next steps in improving obstetrics care.
