Author(s): Schram C.
Source: BJOG: An International Journal of Obstetrics and Gynaecology; Mar 2017; vol. 124 ; p. 62-63
Publication Date: Mar 2017
Publication Type(s): Conference Abstract
Abstract:The 2015 Montgomery versus Lanarkshire decision made it clear that it is incumbent on obstetricians to provide information that is 'material' to the woman's decision making in pregnancy and childbirth, providing her with all the information and options to make an informed choice. We audited 132 pregnancy records (all in 2015) of women who had a breech presentation at term. The audit demonstrated that in our busy district general unit (+/-7000 births/year), nearly a third of breech presentations were not diagnosed prior to labour commencing. Of those that were diagnosed before labour, nearly three quarters were diagnosed because they had a scan for another reason, usually growth. Two thirds of the women in our audit, in whom the breech was not diagnosed until labour, opted for caesarean section. In the other third, two thirds delivered vaginally, compared with half diagnosed before labour. However, documentation of counselling regarding mode of delivery was poor, e.g. there was little documented evidence of information from the Term Breech Trial, or regarding the increased risks of a CS during active labour. Of those planning a vaginal birth, no information was provided regarding the success rate in our unit. Should we now provide information to women about the lack of sensitivity of clinical examination for breech presentation, the increased risks of emergency caesarean versus elective caesarean, and counsel those women in active labour, about the lack of clarity about the benefits of an emergency caesarean section for an uncomplicated breech presentation in labour.
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