Management and outcomes of breech presentation at term in Thailand: a systematic review and meta-analysis 10.55131/jphd/2022/200222
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Abstract
There is a continuous debate on the management of term breech presentation (TBP) regarding the mode of delivery. Limited information about TBP and an absence of Thai national guidelines have led to differences in practices for the mode of delivery. This study aims to describe term breech management in Thailand, including the percentage of TBP and mode of delivery, external cephalic version (ECV) outcomes, and maternal and neonatal outcomes following cesarean section (CS) and vaginal breech birth (VBB). A comprehensive electronic database search was performed in MEDLINE, CINAHL, EMBASE, BNI, MIDIRS, CENTRAL, Scopus, PubMed and HINARI, ThaiJO and J Med Assoc Thai. All databases were searched for updates up to the 7th of April 2021 and reference lists of relevant studies were searched. Inclusion criteria consisted of primary studies assessing the management of TBP, including ECV (≥36 weeks’ gestation) and mode of delivery at term (≥37 weeks’ gestation); and studies that observed maternal or neonatal outcomes following mode of breech delivery in Thailand. The NICE methodology checklist for cohort studies was utilized to assess the risk of bias in individual studies. To synthesise the findings, a combination of meta-analysis and narrative synthesis was utilised, based on the research questions and data of the included studies. Ten studies with a total of 5112 women were included. TBP represented 89.78% of all breech deliveries in Thailand. The average success rate of ECV was high at 70%, with few complications reported and a CS rate reduction, although only in two small studies. Within the VBB group when compared with CS, the pooled estimates of neonatal outcomes including 1- and 5-minute Apgar score, birth trauma, NICU admission, neonatal death and subgroup perinatal death, showed higher risks, with only neonatal jaundice being lower. Maternal outcomes including puerperal fever and postpartum haemorrhage, indicated a lower risk following VBB compared to CS.
TBP was associated with an increased CS rate. A focus on this population could help to reduce the national CS rate. ECV as a standard practice would be a beneficial national policy. Controversies amongst mode of birth for TBP regarding neonatal and maternal outcomes remain, as existing evidence is of a very low quality. The evidence strongly supports a need for VBB skills training to improve neonatal outcomes, for planned or unplanned VBBs. Current approaches require reconsideration and standardization of practices and skills. Scaling up the quality and quantity of breech research in Thailand is needed, along with establishing the national guideline.
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