Question: What is evidence based management for breech at term with intrauterine fetal death in labour with previous Lower Segment Cesarean section (Lscs)?
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Answer: Only one case report of breech delivery after intrauterine fetal death with prior caesarean was identified (1). This was a vaginal delivery in a woman with two prior caesarean sections.
(Evidence level III)
The RCOG guideline on Late Intrauterine Fetal Death and stillbirth (2) makes no reference to breech presentation, but has the following recommendations for women labouring with a scarred uterus:
"Women undergoing VBAC should be closely monitored for features of scar rupture.
Oxytocin augmentation can be used for VBAC, but the decision should be made by a consultant obstetrician".
(Evidence level IV)
References:
- Al Nuaim LA. Mustafa MS. Vaginal breech delivery or a third cesarean section for intrauterine fetal demise. International Journal of Gynaecology & Obstetrics. 52(2):183-4, 1996 Feb.
- RCOG. Late Intrauterine Fetal Death and stillbirth. Green-top Guideline 55. London: RCOG, 2010.
Search date: September 2011
Classification of evidence levels
Ia Evidence obtained from meta-analysis of randomised controlled trials.
Ib Evidence obtained from at least one randomised controlled trial.
IIa Evidence obtained from at least one well-designed controlled study without randomisation.
IIb Evidence obtained from at least one other type of well-designed quasi-experimental study.
III Evidence obtained from well-designed non-experimental descriptive studies, such as comparative studies, correlation studies and case studies.
IV Evidence obtained from expert committee reports or opinions and/or clinical experience of respected authorities.
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