What is A 30-year-old G2P1001 patient comes to see you in the office at 37 weeks gestational age for her routine OB visit. Her first pregnancy resulted in a vaginal delivery of a 9-lb, 8-oz baby boy after 30 min of pushing. On doing Leopold maneuvers during this office visit, you determine that the fetus is breech. Vaginal exam demonstrates that the cervix is 50% effaced and 1 to 2 cm dilated. The presenting breech is high out of the pelvis. The estimated fetal weight is about 7 lb. You send the patient for a sonogram, which confirms a fetus with a frank breech presentation. There is a normal amount of amniotic fluid present, and the head is well flexed. As the patient's obstetrician, you offer all the following possible management plans except and explain in detail?
The patient who has a fetus with a breech presentation has the option of scheduling an elective cesarean section at or after 39 weeks, or alternatively can elect to have a breech delivery if certain conditions are met. It is inappropriate to electively deliver any patient prior to 39 weeks without a documentation of fetal lung maturity because of the risk of neonatal respiratory distress syndrome. Therefore, if a patient declines to undergo a vaginal breech delivery, an elective cesarean should be scheduled at or after 39 weeks gestational age to avoid this complication of preterm delivery. If a patient would like to avoid a cesarean section but does not want to undergo a vaginal breech delivery, then an external cephalic version is an appropriate management plan. An external cephalic version (ECV) is a procedure where the fetus with a breech presentation is manipulated through the abdominal wall to change the presenting part to vertex. Studies indicate that if an ECV is not performed, 80% of breech presentations will persist at term vs. only 30% if a successful version is performed. ECV has an average success rate of about 60%; it is most successful in parous women with an unengaged breech and a normal amount of amniotic fluid (all conditions that exist in the patient described). A trial of labor for a pregnant woman with a fetus in the breech presentation is appropriate if the fetus is frank breech, has a flexed head, has a normal amount of amniotic fluid, and has an estimated weight between 2500 and 3800 g. In addition, the pelvis should be adequate as assessed with x-ray pelvimetry or a history of delivery of a previous baby of bigger size.