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J Matern Fetal Neonatal Med. 2011 Mar;24(3):475-9. doi: 10.3109/14767058.2010.510895. Epub 2010 Sep 1.

Cesarean or vaginal delivery for the breech fetus at the threshold of viability: results from a maternal-fetal medicine specialists survey.

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  • 1Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of South Florida College of Medicine, Tampa, FL 33606, USA. abdmd2003@hotmail.com

Abstract

OBJECTIVE:

To determine how United States Maternal-Fetal medicine specialists recommend delivery of a breech fetus at the threshold of viability.

METHODS:

U.S. Society for Maternal-Fetal Medicine (SMFM) members were surveyed about; geographic location, practice type, whether they performed deliveries, definition of threshold for viability, recommendations for delivery of a breech fetus at the threshold of viability, and if the current medical-legal climate had any bearing on their decisions. Chi-Square and Fisher's Exact tests were used for analysis.

RESULTS:

510 SMFM members responded to the questionnaire. The highest percentage of respondents stated '23 weeks' (31%) as the cutoff for viability, followed by '24 weeks' (21%) and '23 weeks or 500 g' (10%). Seventy percent recommended cesarean delivery for a breech fetus at the threshold of viability. The majority of respondents based their decision on 'published data' or 'expert opinion', however, 58.6% reported they felt current medical evidence was inadequate to support a recommendation. Fifty-three percent stated their recommendations are affected by medical-legal concerns.

CONCLUSION:

The majority of U.S. maternal fetal-medicine specialists who responded would recommend cesarean delivery for a breech fetus at the threshold of viability, despite the belief that there is inadequate evidence in the literature to support this recommendation.

PMID:
20807158
[PubMed - indexed for MEDLINE]
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