{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T08:58:04Z","timestamp":1765961884613,"version":"3.40.5"},"reference-count":31,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T00:00:00Z","timestamp":1743465600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Vaginal delivery in cases of breech presentation is considered potentially stressful for the newborn. The maternal upright position may represent a more physiological approach to facilitating birth. We compare the safety and efficacy of two maternal positions in vaginal breech delivery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and Methods<\/jats:title><jats:p>A prospective, single\u2010center, observational cohort study from October 2006 to January 2021 in a high\u2010level obstetric center, in Salzburg, Austria. Vaginal breech deliveries in maternal all\u2010fours position (<jats:italic>n<\/jats:italic>\u2009=\u2009140) were compared with those in assisted supine position (<jats:italic>n<\/jats:italic>\u2009=\u200992). The primary outcome measures for neonatal morbidity included Apgar scores, pH levels, and the rate of transfer to the Neonatal Intensive Care Unit (NICU) postdelivery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the all\u2010fours position, 51.4% (<jats:italic>n<\/jats:italic>\u2009=\u200972) of deliveries occurred without obstetric intervention. The second stage of labor was significantly shorter in the supine position (39.5\u2009min [95% CI 28\u201347] versus all fours position 52\u2009min [95% CI 42\u201363], <jats:italic>p<\/jats:italic>\u2009=\u20090.042). Umbilical artery pH levels did not differ significantly (7.21 [95% CI 7.19\u20137.23] versus 7.19 [95% CI 7.17\u20137.21] vs. <jats:italic>p<\/jats:italic>\u2009=\u20090.06). Nor did the APGAR scores at 5 and 10\u2009min below eight (<jats:italic>p<\/jats:italic>\u2009=\u20090.697; <jats:italic>p<\/jats:italic>\u2009=\u20090.760). Maternal and neonatal morbidity also did not significantly differ. Transfer of neonates to NICU <jats:italic>n<\/jats:italic>\u2009=\u200912 (13%) versus <jats:italic>n<\/jats:italic>\u2009=\u200911 (7.9%), <jats:italic>p<\/jats:italic>\u2009=\u20090.097, transfer birth\u2010related <jats:italic>n<\/jats:italic>\u2009=\u20096 (6.5%) versus <jats:italic>n<\/jats:italic>\u2009=\u20098 (5.7%), <jats:italic>p<\/jats:italic>\u2009=\u20090.803. The number of postpartum umbilical artery pH\u2009&lt;\u20097.10 were <jats:italic>n<\/jats:italic>\u2009=\u20099 (9.8%) versus <jats:italic>n<\/jats:italic>\u2009=\u200928 (20%), <jats:italic>p<\/jats:italic>\u2009=\u20090.065. There was one reported neonatal death due to intracerebral hemorrhage in the supine position group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our results indicate that vaginal breech delivery in the all\u2010fours position seems to be comparable to supine position regarding neonatal safety. Additionally, the all\u2010fours position shows potential for emergency management for unplanned breech deliveries by inexperienced attendants.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.15078","type":"journal-article","created":{"date-parts":[[2025,4,2]],"date-time":"2025-04-02T04:23:06Z","timestamp":1743567786000},"page":"1153-1161","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Vaginal breech delivery in all\u2010fours position\u2014Hands off instead of intervention: A prospective observational study"],"prefix":"10.1111","volume":"104","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4495-1209","authenticated-orcid":false,"given":"Gerhard","family":"Bogner","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Paracelsus Medical University  Salzburg Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johanna","family":"Schuller","sequence":"additional","affiliation":[{"name":"Paracelsus Medical University  Salzburg Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carina","family":"Gargitter","sequence":"additional","affiliation":[{"name":"Department 1, Ref 1\/1, National Competence Measurements &amp; Quality Development Federal Institute for Quality Assurance in the Austrian School System (IQS)  Salzburg Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eva","family":"D\u00f6lzlm\u00fcller","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Paracelsus Medical University  Salzburg Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thorsten","family":"Fischer","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Paracelsus Medical University  Salzburg Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudius","family":"Fazelnia","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Paracelsus Medical University  Salzburg Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,4]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.3109\/14767058.2013.806891"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(00)02840-3"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2005.00739.x"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2022.10.022"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2004.06.056"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.12449"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13524"},{"key":"e_1_2_11_9_1","first-page":"E152","article-title":"Management of breech presentation","volume":"124","author":"Impey L","year":"2017","journal-title":"BJOG"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2016-014979"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2009.07.002"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2005.10.817"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0202760"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajo.12208"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0412.2012.01488.x"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jogc.2018.12.018"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1515\/jpm-2022-0202"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.14570"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.12033"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1515\/jpm-2014-0048"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.midw.2016.09.003"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2014.06.029"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-022-06671-5"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/birt.12480"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1515\/jpm.2011.044"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.14947"},{"issue":"285","key":"e_1_2_11_27_1","first-page":"e1","article-title":"Factors associated with adverse perinatal outcomes for term breech fetuses with planned vaginal delivery","volume":"207","author":"Azria E","year":"2012","journal-title":"Am J Obstet Gynecol"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1067\/S0002-9378(03)00822-6"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1515\/jpm-2015-0342"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1111\/birt.12808"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.14945"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10102117"}],"container-title":["Acta Obstetricia et Gynecologica Scandinavica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/aogs.15078","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T17:02:42Z","timestamp":1747674162000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1111\/aogs.15078"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4]]},"references-count":31,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,6]]}},"alternative-id":["10.1111\/aogs.15078"],"URL":"https:\/\/doi.org\/10.1111\/aogs.15078","archive":["Portico"],"relation":{},"ISSN":["0001-6349","1600-0412"],"issn-type":[{"type":"print","value":"0001-6349"},{"type":"electronic","value":"1600-0412"}],"subject":[],"published":{"date-parts":[[2025,4]]},"assertion":[{"value":"2024-09-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-02-04","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-04-01","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}