last updated 10.10.2004

CONTENTS:

a)Clinical opinions about breech vaginal delivery

b)Natural methods for turning breech presentation in head presentation>

A)Clinical opinions

Date: Thu, 19 Nov 1998 12:59:21 -0600

Reply-To: ob-gyn-l@obgyn.net

Originator: ob-gyn-l

Sender: ob-gyn-l@obgyn.net

From: Porro Emilio

To: Multiple recipients of list

Subject: BREECH PRESENTATION FIRST RISK,VAGINAL BREECH DELIVERY SECOND

X-Comment: Obstetrics & Gynecology for Medical Professionals ONLY

>I have some doubts:why a breech vaginal delivery(added risk)for

>a breech presentation baby (who may have preexisting neurological problems)?

>Do You want to stress more a probably already stressed baby ?

>Yours faithfully

>Emilio Porro

>You wrote

>Braun, R. Daniel wrote:

>

>> The best real data I have is observational. When my eldest son was about 5,

>> he had a functional speech problem. One day, I took him for his speech

>> therapy session and while I was waiting for him, the young receptionist

>> sitting at the desk asked me a question. She wanted to know, since I was an

>> Obstetrician, why almost all of the children brought in for CP and other

>> neurologic problems had been delivered breech. I must admit, this made an

>> impression on me. For all practical purposes, no one has been able to

really address this issue in a manner that really answers the question. At least

>> not that I have been able to find.

>>Dan

>>

>> R.Daniel Braun, MD FACOG

>> Clinical Professor of Obstetrics and Gynecology

>> Indiana University School of Medicine

>> Indianapolis, IN

>>

But what is the incidence of preexisting neurological problem which may

>contribute to the breech presentation in the first place? Chicken or egg?

>

>Cheri Van Hoover, CNM

>Midwifery Service at Stanford

>

>

>

Porro Emilio

Ob-Gyn.M.D.

Via Zezio 69

22100 COMO (Alessandro Volta City)

ITALY

phone:031/30 21 46

e-mail:sanbonav@tin.it

Who,Whom,Which,With,What,Why,Where,When,Whose,Whole,Want,Wether,While,

Whatever,Watch WORLD WIDE WEB

OTHER OPINION

Date: Wed, 12 Jul 2000 10:47:28 -0500

Reply-To: ob-gyn-l@obgyn.net

Originator: ob-gyn-l

Sender: ob-gyn-l@obgyn.net

From: john.robertson@obgyn.net (John Robertson MD)

To: Multiple recipients of list OB-GYN-L

Subject: Route of delivery for breech presentation

X-Comment: Obstetrics & Gynecology for Medical Professionals ONLY

Here is the web site for that article.

http://www.medicalpost.com/mdlink/english/members/medpost/data/3625/01B.HTM

the text follows:

VOLUME 36, NO. 25, July 4, 2000

--------------------------------------------------------------------------------

C-section best for breech

Study comparing vaginal deliveries halted early due to success rates

By Jenny Manzer MONTREAL – A worldwide investigation into whether vaginal deliveries or cesarean sections are best for breech births has ended early—C-sections have already come out on top. Data monitors for the Term Breech Trial requested the study be stopped in late April after an interim analysis showed a significant difference between the two groups, said principal investigator Dr. Mary Hannah, director of the Maternal, Infant and Reproductive Health Research Unit at the University of Toronto. "Two months ago we could say to the patients we don't really know which is better," said Dr. Hannah, professor of obstetrics and gynecology. "Now we can say to the patient that the study is no longer ongoing and that the trial was stopped because results showed elective cesarean section was better." The study objective was to determine if a planned C-section resulted in less risk of perinatal mortality or serious neonatal morbidity to the term breech fetus. The primary outcome is a composite of infant mortality, neonatal morbidity and serious maternal complications. Researchers also checked in with the mothers at three months and two years, collecting data on outcomes such as postpartum depression, pain, urinary and fecal incontinence, and the impact on sexual relations and breastfeeding. The infants were also followed up at two years to assess their developmental status. "That's what's important, how the babies do ultimately. And there are a lot of issues related to cesarean section and mode of delivery and the outcomes for mothers, and we don't have any information from any randomized studies on that—none," said Dr. Hannah. She said the study was a unique opportunity, and unlikely to be repeated in the near future due to the difficulty and the expense involved. Results from the more than $2-million study, funded by the Medical Research Council of Canada (now the Canadian Institute for Health Information) are expected this fall. "Publication, we hope, will be expedited, and we will have complete data for you we hope as early as the SOGC meeting in Ontario in November," Dr. Hannah told colleagues at the Society of Obstetricians and Gynecologists of Canada (SOGC) annual clinical meeting here. Recruitment for the study, originally expected to last five years, began in early 1997. Women eligible for the study had a frank or complete breech presentation at 37 weeks or more, with a baby who appeared small enough to fit through her pelvis, and who had no evidence of a congenital defect. All those enrolled had exhausted the possibility of having the baby turned by external cephalic version. By late April, 2,088 women had been recruited. Researchers had preplanned an interim analysis after the first 1,000 women had been recruited. The data monitoring committee then requested a second interim analysis, which was completed using data from 1,600 women. Following the second interim analysis, the data monitoring group requested that randomization be halted in keeping with the study protocol to stop if one group showed a statistically significant difference (p less of 0.002). >

Asked if clinicians should stop doing vaginal breech deliveries until final results are available, Dr. Hannah said, "I would suggest that you inform patients this trial was stopped because cesarean was better, that we're waiting for the final results. I think that information should be available to women when they make their decision with you about what's best for them." The Term Breech Trial spanned the globe, with participants in more than 25 countries from Argentina to Zimbabwe. Participating centres ensured the vaginal births were done by clinicians experienced and skilled at breech delivery. Noting the diversity of the participating centres, Dr. Hannah said the data monitoring committee did not feel the differences between the two study groups were related to isolated or small centres. "We will be looking at that in more detail," she added. "We need more information and we will have that shortly."

--

J.G.M.Robertson MD, 109-9181 Main St. Chilliwack, B.C. V2P 4M9

(604) 793-9988 e-mail john.robertson@obgyn.net Who is wise and understanding among you? Let him show it by his good life, by deeds done in the humility that comes from wisdom. James 3 vs 13, NIV

OTHER OPINION

Date: Fri, 20 Oct 2000 08:21:49 -0500

Reply-To: ob-gyn-l@obgyn.net

Originator: ob-gyn-l

Sender: ob-gyn-l@obgyn.net

From: evsono@pipeline.com (art fougner, md)

To: Multiple recipients of list OB-GYN-L

Subject: OB: Section Best For Breech

X-Comment: Obstetrics & Gynecology for Medical Professionals ONLY

This in tomorrow's Lancet -

Home The Journal Current Issue Original research

Volume 356, Number 9239 21 October 2000

Articles

Planned caesarean section versus planned vaginal birth for breech

presentation at term: a randomised multicentre trial

Mary E Hannah, Walter J Hannah, Sheila A Hewson, Ellen D Hodnett, Saroj

Saigal, Andrew R Willan, for the Term Breech Trial Collaborative Group*

--------------------------------------------------------------------------------

*Members listed at end of paper Department of Obstetrics and Gynaecology, Sunnybrook and Women's College Health Sciences Centre (M Hannah MDCM, W Hannah MD); Maternal Infant and Reproductive Health Research Unit, Centre for Research in Women's Health, (M Hannah, S Hewson BA, E Hodnett PhD, A Willan PhD) and Faculty of Nursing (E Hodnett), University of Toronto, Toronto; and Departments of Paediatrics (S Saigal MD) and Clinical Epidemiology and Biostatistics (A Willan, M Hannah), McMaster University, Hamilton, Ontario, Canada Correspondence to: Dr Mary E Hannah, University of Toronto, Maternal Infant and Reproductive Health Research Unit, Centre for Research in Women's Health, Toronto, Ontario M5G 1N8, Canada (e-mail:mary.hannah@utoronto.ca)

Summary

Background For 3-4% of pregnancies, the fetus will be in the breech presentation at term. For most of these women, the approach to delivery is controversial. We did a randomised trial to compare a policy of planned caesarean section with a policy of planned vaginal birth for selected breech-presentation pregnancies.

Methods At 121 centres in 26 countries, 2088 women with a singleton fetus in a frank or complete breech presentation were randomly assigned planned caesarean section or planned vaginal birth. Women having a vaginal breech delivery had an experienced clinician at the birth. Mothers and infants were followed-up to 6 weeks post partum. The primary outcomes were perinatal mortality, neonatal mortality, or serious neonatal morbidity; and maternal mortality or serious maternal morbidity. Analysis was by intention to treat.

Findings Data were received for 2083 women. Of the 1041 women assigned planned caesarean section, 941 (90·4%) were delivered by caesarean section. Of the 1042 women assigned planned vaginal birth, 591 (56·7%) delivered vaginally. Perinatal mortality, neonatal mortality, or serious neonatal morbidity was significantly lower for the planned caesarean section group than for the planned vaginal birth group (17 of 1039 [1·6%] vs 52 of 1039 [5·0%]; relative risk 0·33 [95% CI 0·19-0·56]; p<0·0001).> There were no differences between groups in terms of maternal mortality or serious maternal morbidity (41 of 1041 [3·9%] vs 33 of 1042 [3·2%]; 1·24 [0·79-1·95]; p=0·35).

Interpretation Planned caesarean section is better than planned vaginal birth for the term fetus in the breech presentation; serious maternal complications are similar between the groups.

Lancet 2000; 356: 1375-83

art

art fougner, md

SonoScan/Genetic Sciences

forest hills, ny

evsono@pipeline.com

A series of 1000 cases begins with but a single anecdote.


B)natural methods for preventing breech births

Natural products most used to prevent breech birth are homeopathic products and moxa on

acupuncture points

1)Homeopathic products:(taken in a period between 32 to 35 weeks of gestation)

PULSATILLA 30 CH granules (French homeopathy) five granules under tongue four o five times a day for three or four days

or

PULSATILLA 200 CH one tube of globules (French homeopathy) half a tube under tongue a day the other half under tongue the next day

2)Moxibustion on acupuncture points
URINARY BLADDER 67 bilaterally with moxa CIGARS

Moxibustion Explained : Moxibustion is the application of heat to acupuncture points or to other areas of the body by the use of the herb Artemisia vulgaris latiflora, commonly known as moxa. To treat a specific point, the herb is generally powdered, rolled into a small cone,and then placed on a point and lit. In this country, the smoldering cone is generally removed when the patient feels the heat. Traditionally the cone was, in certain circumstances, allowed to burn down to the skin. To treat a larger area, such as the shoulder or lower back, the moxa is rolled into a "cigar" which is then lit and held over the area to be warmed. This treatment is generally used to warm an individual's qi, primarily in cases where they are Yang deficient. It tends to be used more in the Winter and in cold, damp climates.

News and Press Releases

Acupuncture method helps prevent breech birth

November 11, 1998

NEW YORK (Reuters Health) -- A traditional Chinese treatment for preventing breech birth -- burning herbs over an acupuncture point on the mother's toe a few weeks before delivery -- appears to safely increase the odds of a normal vertex (head-first) position of the infant in time for delivery among first-time mothers, researchers report. The study is published in the November 11th issue of The Journal of the American Medical Association.

A fetus in a breech position -- knees-, feet-, or buttocks-first -- runs a higher risk of injury during vaginal delivery. Physicians often perform cesarean sections in these cases, but may also try to manually move the baby into a head-first position using a technique called external cephalic version (ECV) before attempting a vaginal delivery. In contrast, practitioners of traditional Chinese medicine use a treatment called "moxibustion" -- burning small cones of mugwort, an herb, over an acupuncture point on the outer corner of the mother's small toenail. According to traditional Chinese medicinal precepts, heat from the burning herb "stimulates" the acupoint.

To test the treatment's efficacy, Dr. Francesco Cardini, a private practitioner in Verona, Italy, and Dr. Huang Weixin of Jiangxi Women's Hospital in Nanchang, China, studied 260 Chinese women who were about to deliver their first babies. The women were in the 33rd week of pregnancy -- a point at which the fetus has usually turned so it is in a head-down position. Ultrasound scans, however, showed that these women's fetuses were still in a head-up position.

In the study, 130 of the women had either one or two half-hour moxibustion treatments every day for a week. If the fetus still had not turned so it was head-down after 1 week, the mother received a second week of treatment. The other 130 women received no treatment for breech presentation during those 2 weeks. After the 2-week period, all women in both groups were given the option of having ECV if their fetus had not moved into the correct position.

Women in both groups were asked to count fetal movements for 1 hour per day during the first week of the study. Mothers who had moxibustion treatment reported an average of 48.45 fetal movements, while those who received no treatment reported an average of 35.35 movements, according to Cardini and Weixin. At the 35th week of pregnancy, 75.4% of the fetuses whose mothers had moxibustion treatment had turned and were head-down, compared with 47.7% of those whose mothers had not had the treatment.

Two half-hour moxibustion treatments per day showed results faster than one treatment per day, the researchers note. Only one mother in the treatment group opted for ECV after week 35, compared with 24 in the no-treatment group. While more than 75% of mothers in the moxibustion treatment group had normal head-first deliveries, only about 62% of mothers who had not received moxibustion treatment had head-first deliveries. The moxibustion treatment appeared to cause no adverse side effects.

"The mechanism of action of moxibustion appears to be through increased (fetal movements), which proved significantly stronger in the treated subjects," the researchers write. "As we see it, if the results of this trial are confirmed, moxibustion should be extensively used on account of its noninvasiveness, low cost, and ease of execution. In fact, it is easy to train expectant mothers (either alone or with their partners) to administer the therapy at home."

Cardini and Weixin conclude.

SOURCE: The Journal of the American Medical Association 1998;280:1580-1584. This information is provided for educational purposes only.

LINK
Urinary Bladder 67 acupuncture point picture

LINK
english site where moxa for breech version is well explained;