Breech presentation and shoulder dystocia in childbirth.

This review covers the recent literature relevant to breech presentation and shoulder dystocia. Further evidence in favor of external cephalic version at term has emerged, and the possibility of its use in women with previous cesarean section has been suggested. Attention has been given to trial of labor in selected cases of term breech presentation. The evidence to guide the method of delivery for preterm breech presentations remains inadequate. No perinatal differences have been demonstrated among the outcome of breech second-born twins delivered by external cephalic version, breech extraction, or cesarean section. The evidence in favor of elective cesarean for suspected macrosomia to prevent shoulder dystocia is unconvincing for nondiabetics and is doubtful for pregnant diabetics. The McRoberts maneuver for shoulder dystocia has not received the prominence that it deserves.