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Optimal time intervals for vaginal breech births: a case-control study [version 2; peer review: 1 approved, 2 approved with reservations, 1 not approved] (Record no. 1013)

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Personal name Spillane, Emma
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9 (RLIN) 3167
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Title Optimal time intervals for vaginal breech births: a case-control study [version 2; peer review: 1 approved, 2 approved with reservations, 1 not approved]
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Date of publication, distribution, etc. 2022-09-16.
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General note /pmc/articles/PMC7614205/
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General note /pubmed/36811097
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Summary, etc. BACKGROUND: Breech births are associated with a high rate of hypoxic injury, in part due to cord occlusion during emergence. Maximum time intervals and guidelines oriented toward earlier intervention have been proposed in a Physiological Breech Birth Algorithm. We wished to further test and refine the Algorithm for use in a clinical trial. METHODS: We conducted a retrospective case-control study in a London teaching hospital, including 15 cases and 30 controls, during the period of April 2012 to April 2020. Our sample size was powered to test the hypothesis that exceeding recommended time limits is associated with neonatal admission or death. Data collected from intrapartum care records was analysed using SPSS v26 statistical software. Variables were intervals between the stages of labour and various stages of emergence (presenting part, buttocks, pelvis, arms, head). The chi-square test and odds ratios were used to determine association between exposure to the variables of interest and composite outcome. Multiple logistic regression was used to test the predictive value of delays defined as non-adherence the Algorithm. RESULTS: Logistic regression modelling using the Algorithm time frames had an 86.8% accuracy, a sensitivity of 66.7% and a specificity of 92.3% for predicting the primary outcome. Delays between umbilicus and head >3 minutes (OR: 9.508 [95% CI: 1.390-65.046] p=0.022) and from buttocks on the perineum to head >7 minutes (OR: 6.682 [95% CI: 0.940-41.990] p=0.058) showed the most effect. Lengths of time until the first intervention were consistently longer among the cases. Delay in intervention was more common among cases than head or arm entrapment. CONCLUSION: Emergence taking longer than the limits recommended in the Physiological Breech Birth algorithm may be predictive of adverse outcomes. Some of this delay is potentially avoidable. Improved recognition of the boundaries of normality in vaginal breech births may help improve outcomes.
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Terms governing use and reproduction
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Terms governing use and reproduction https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Language note en
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Topical term or geographic name as entry element Article
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Genre/form data or focus term Text
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Personal name Walker, Shawn
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9 (RLIN) 3168
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Personal name McCourt, Christine
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9 (RLIN) 3169
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Note NIHR Open Res
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Uniform Resource Identifier <a href="http://dx.doi.org/10.3310/nihropenres.13297.2">http://dx.doi.org/10.3310/nihropenres.13297.2</a>
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