PLD.55 Introduction of Breech Clinic in a tertiary care setting to aid informed decision-making in mothers with breech presentation at term

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Abstract

Background

The incidence of breech presentation is 3–4% at tem. Since the publication of Term Breech Trial, elective Caesarian section (ELCS) has been the default mode of delivery with little or no opportunity for mothers to consider alternative approaches to manage breech presentation at term.

Methods

Once a week Breech Clinic was introduced in June 2012 with a dedicated team of two midwives and two consultant obstetricians who are trained to counsel the mothers to aid informed decision making on their management and to undertake external cephalic version (ECV) if agreed. All mothers with breech presentation of a singleton fetus over 35 weeks of gestation with no known contraindications were booked to attend “Breech Clinic” at 37 weeks of gestation. They were provided with an information leaflet to read prior to the clinic appointment, and a detailed consultation on different approaches such as ECV, vaginal breech delivery (VBD) or ELCS was carried out with ample time for mothers to make their decision.

Results

Since the implementation of Breech Clinic, more mothers are accepting ECV as their first choice, reaching a rate of 97% at the end of one-year period. 36% of attempted ECVs were successful with 80% of them achieving vaginal deliveries. 10% of mothers with unsuccessful ECVs opted for VBD over elective CS and eventually achieved vaginal deliveries.

Conclusion

Introduction of Breech Clinic provides an opportunity for mothers to make an informed decision on the management of breech presentation resulting in higher acceptance of alternative approaches over ELCS.

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