Cephalic Version in Breech Presentation

Breech delivery has a usual incidence of about 4 per cent, and virtually all obstetricians agree that the infantile mortality in these cases exceeds that of vertex delivery and the danger of serious injury to the baby is increased. The fetal hazard may be reduced, at some added risk to the mother, by extending the indications for Cesarian section, particularly in elderly primigravid patients, or those with borderline cephalopelvic dysproportion. For infants delivered vaginally, the skillful conduct of labor is of preeminent importance. There are, indeed, a few reports, such as those of Gustafson,' Hansen,8 and Arnot and Nelson,' of breech deliveries done with extraordinarily little fetal loss attributable to delivery itself. These excellent results were achieved in private practices and are a tribute to the unusual dexterity and obstetrical judgment of the authors. In a large series of cases from a hospital service, Seeley' found that even with expert management the corrected fetal mortality for viable term babies was three or four times greater for breech than for other deliveries. Guyer and Heaton' found a four and a half times greater fetal risk inherent in breech delivery. The experience of most others'9',10',1 ,15,17 seems to range from results approximately as good as these to considerably worse; though it is difficult to compare published reports, since the various authors use different standards for correction of their statistics. The consensus leaves little doubt, however, that survival and well-being of the baby are jeopardized by breech delivery. Management of the patient with breech presentation therefore presents a problem deserving of careful consideration. Another approach to this problem is to reduce the incidence of breech delivery by the practice of external cephalic version during the latter part of pregnancy. This is advised by the great majority of authors. Seeley' found seventeen of twenty-three recommending it. Version is advised, for selected cases at least, by the authors of fourteen of the papers in the bibliography of this report, while the authors of but one1 consider it of little value; the remainder omitting all discussion of version8' or reporting briefly some unusual complications.' u Bartholomew8 estimated that the frequency of breech deliveries may be reduced 80 to 90 per cent by the routine practice of external version during the last two months of pregnancy, but actual reports hardly approach this measure of success, probably