[When to perform a cesarean section in breech presentation].

A German court (Oberlandesgericht Hamm, 4. 11. 1981) has ruled that a gynaecologist cannot be accused of having committed an error in treatment if he does not recommend Caesarean section in a multipara and breech presentation if the birth proceeds in all other respects in a normal manner and if there is no disproportion between the child and the maternal pelvis. Vaginal birth in case of breech presentation in a women who has been pregnant six times and has given birth to three children, is in accordance with good medical practice. It was also ruled that the obstetrician cannot be considered at fault if he has not fully recognized the pathological changes (especially paralysis of the plexus) in the child and if he has not initiated the requisite measures in time. It is stated that control of the foetal heart sounds and of breathing are matters of major importance to the gynaecologist. As a matter of fact, in this case the changes became evident two or three days later only.