{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T06:40:54Z","timestamp":1775198454001,"version":"3.50.1"},"update-to":[{"DOI":"10.3310\/nihropenres.13297.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2022,9,16]],"date-time":"2022-09-16T00:00:00Z","timestamp":1663286400000}}],"reference-count":33,"publisher":"National Institute for Health and Care Research","license":[{"start":{"date-parts":[[2022,9,16]],"date-time":"2022-09-16T00:00:00Z","timestamp":1663286400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute of Health Research","doi-asserted-by":"crossref","award":["NIHR300582"],"award-info":[{"award-number":["NIHR300582"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["openresearch.nihr.ac.uk"],"crossmark-restriction":false},"short-container-title":["NIHR Open Res"],"abstract":"<ns4:p>\n                    <ns4:bold>Background:<\/ns4:bold>\n                    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.\n                  <\/ns4:p>\n                  <ns4:p>\n                    <ns4:bold>Methods:<\/ns4:bold>\n                    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.\u00a0 Multiple logistic regression was used to test the predictive value of delays defined as non-adherence the Algorithm.\n                  <\/ns4:p>\n                  <ns4:p>\n                    <ns4:bold>Results:<\/ns4:bold>\n                    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 &gt;3 minutes (OR: 9.508 [95% CI: 1.390-65.046]\n                    <ns4:italic>p<\/ns4:italic>\n                    =0.022) and from buttocks on the perineum to head &gt;7 minutes (OR: 6.682 [95% CI: 0.940-41.990]\n                    <ns4:italic>p<\/ns4:italic>\n                    =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.\n                  <\/ns4:p>\n                  <ns4:p>\n                    <ns4:bold>Conclusion:<\/ns4:bold>\n                    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.\n                  <\/ns4:p>","DOI":"10.3310\/nihropenres.13297.2","type":"journal-article","created":{"date-parts":[[2022,9,16]],"date-time":"2022-09-16T11:15:07Z","timestamp":1663326907000},"page":"45","update-policy":"https:\/\/doi.org\/10.3310\/nihropenres.crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["Optimal time intervals for vaginal breech births: a case-control study"],"prefix":"10.3310","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6663-7093","authenticated-orcid":false,"given":"Emma","family":"Spillane","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3658-8988","authenticated-orcid":false,"given":"Shawn","family":"Walker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4765-5795","authenticated-orcid":false,"given":"Christine","family":"McCourt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"6221","published-online":{"date-parts":[[2022,9,16]]},"reference":[{"key":"ref-1","article-title":"NHS Maternity Statistics, 2018\u20132019."},{"key":"ref-2","article-title":"Five years of cerebral palsy claims: A thematic review of NHS Resolution data.","author":"M Magro"},{"key":"ref-3","doi-asserted-by":"publisher","first-page":"e151-e177","DOI":"10.1111\/1471-0528.14465","article-title":"Management of Breech Presentation: Green-top Guideline No. 20b.","volume":"124","author":"L Impey","year":"2017","journal-title":"BJOG."},{"key":"ref-4","doi-asserted-by":"publisher","first-page":"1444-1453","DOI":"10.1111\/1471-0528.16634","article-title":"Using Robson's Ten-Group Classification System for comparing caesarean section rates in Europe: an analysis of routine data from the Euro-Peristat study.","volume":"128","author":"J Zeitlin","year":"2021","journal-title":"BJOG."},{"key":"ref-5","doi-asserted-by":"publisher","first-page":"e1003503","DOI":"10.1371\/journal.pmed.1003503","article-title":"The impact of a routine late third trimester growth scan on the incidence, diagnosis, and management of breech presentation in Oxfordshire, UK: A cohort study.","volume":"18","author":"I Salim","year":"2021","journal-title":"PLoS Med."},{"key":"ref-6","doi-asserted-by":"publisher","first-page":"41-47","DOI":"10.1016\/j.midw.2016.11.005","article-title":"'Stress, anger, fear and injustice': An international qualitative survey of women's experiences planning a vaginal breech birth.","volume":"44","author":"K Petrovska","year":"2017","journal-title":"Midwifery."},{"key":"ref-7","doi-asserted-by":"publisher","first-page":"114-122","DOI":"10.1016\/j.midw.2019.08.006","article-title":"What if something goes wrong? 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Bovbjerg, Epidemiology Program, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, 20 Dec 2022, version 2, indexed","URL":"https:\/\/openresearch.nihr.ac.uk\/articles\/2-45\/v2#referee-response-28865","order":2,"name":"referee-response-28865","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.3310\/nihropenres.14441.r28863, Rachna Bahl, Department of Obstetrics and Gynaecology, St. Michael's Hospital, University of Bristol, Bristol, 11 Jan 2023, version 2, indexed","URL":"https:\/\/openresearch.nihr.ac.uk\/articles\/2-45\/v2#referee-response-28863","order":3,"name":"referee-response-28863","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"SW is funded by a National Institute of Health Research (NIHR300582) Advanced Fellowship. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":4,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}