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Undiagnosed breech: now more important?

The management of breech presentation has changed with the result of the term breech trial. Women with an undiagnosed breech in labour miss antenatal counselling for ECV, which improves the potential for vaginal birth. Therefore the need exists to revisit management of term breech diagnosed for the first time in labour. A retrospective casenote analysis was conducted of women with undiagnosed breech in labour at East Kent NHS Hospitals Trust with 6000 deliveries annually for 2 years. Fifty-five women with breech presentation diagnosed after the onset of labour constituted 14% of total term breech deliveries. Thirty-seven (67%) were delivered by emergency caesarean section. Twenty-four (44%) were fully dilated at diagnosis, of whom 11(46%) had an emergency caesarean section and 13 (54%) had a vaginal breech delivery. In the caesarean section group there was a 38% increase in blood loss and 50% increase in the length of hospital stay compared to the vaginal delivery group.