الفهرس 
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Abstract
Caesarean section has been adopted as the ’normal’ mode of delivery for term breech presentations in Europe and the USA, as the consensus is that this reduces the risk of birth related complications. In the USA, over 85% of all breech births are now by caesarean section (up from 14% in 1970). Intrapartum and neonatal deaths associated with breech presentation appear to have been declining: one study based on Scottish births between 1985 and 2004 showed a 75% decrease in deaths but the increased use of planned caesarean section only partially explained the decrease. Elective vaginal breech delivery continues to be debated. There was no difference in outcome at 2 year follow up. The advantage therefore in a policy of planned elective caesarean section for breech presentation at term is to decrease the short term perinatal and neonatal morbidity and mortality. However, the women selected for vaginal breech birth in the TBT has been questioned. The PREMODA study (2006) assessed French and Belgian practices in breech presentation including their consequences for mother and baby. The results indicated there was no significant difference between the 2 groups in perinatal mortality, neonatal mortality, and severe neonatal mortality. A recent dutch study found that the perinatal mortality was lower in the caesarean section group when compared with the vaginal breech group. However the relative safety of elective caesarean should be weighed against the consequences of a scarred uterus in future pregnancies. Considering the worldwide general rise in caesarean delivery rate in the last decade, and the urgency to put a hold to this rise, ECV is an important intervention that can contribute to this goal. Even though procedure related complications rarely occur, concerns about safety of the procedure can be a reason for women not to accept an ECV attempt, Additionally, knowledge about the effectiveness of ECV also influences acceptance of ECV. The success rate of ECV varies from approximately 35% up to 86% in the literature with an average of 50–60%.Thus, a reliable more precise and individualized prediction of successful ECV could be useful to counsel women for an ECV attempt. Previous studies have shown that clinical and ultrasound characteristics are associated with success or failure of an ECV procedure. There are several prediction models that enable individualized prediction of the outcome of an ECV attempt. However, since the use of poor-quality prediction models could have a negative effect on decision-making. Careful evaluation is needed before these models can be implemented in clinical important predictor variables: parity, placental location, breech engagement, amniotic fluid index, maternal weight, uterine tone and palpation of the fetal head as important predictor variables for successful ECV. Another factor related to ECV outcome is the experience of the operator. Clinical audit is a quality improvement process that was introduced by the National Health Service. The key component of clinical audit is that performance is reviewed to ensure that what should be done is being done, and if not it provide a framework to enable improvements to be made. It involves reviewing the delivery of healthcare to ensure the best practice is being carried out. The overarching aim of clinical audit is to improve professional practice and the general quality of services delivered. It appears logical that health care professionals would be prompted to modify their practice if they given feedback that their clinical practice were inconsistent with that of accepted guidelines. This work auditing the current management of breech presentation at term at Womens Health Hospital, Assuit University Hospitals, El- Kosia hospital. Identifying the gap between the current practice on management of breech presentation at term at Womens Health Hospital, El- Kosia Hospital, and the ideal practice (according to the guidelines of Royal College of Obstetricians and Gynecologists). Improvement of clinical management of breech presentation using locally available resources. Patient recruitment was conducted at Obstetrics and Gynecology Department, Assiut University, and El-Kosia hospital. This audit study, included 334 women recruited from Women’s Health Hospital, Assiut University Hospitals and El-Kosia Hospital. The Ethical Review Board at Faculty of Medicine, Assiut University, has approved the protocol of the study. As regard the incidence of breech was 4.04% at Women’s Health Hospital and 4%at El-Kosia Hospital. The incidence of assisted breech delivery were 20.86% at Women’s Health Hospital as58 out of 287cases managed by NVD. At El-Kosia Hospital the incidence were31.91% as15 out of 47cases managed by NVD. The incidence of C.S were 79.14% at Women’s Health Hospital as229 out of 287cases managed by C.S. At El-Kosia Hospital the incidence were68.09% as32 out of 47cases managed by C.S. The C.S were emergenat in most cases except for 22cases were elective C.S. The cases were frank breech by incidence 50.90% and the rest were complete breech. There were 124 cases primigravida 72 cases were active in labour 11cases manged by assisted breech delivery and the rest by C.S. There were 210 case multigravida 72 case managed by assisted breech delivery and the rest by C.S. There were 40 case were P2 9 cases manged by assisted breech delivery and the rest by C.S. ECV not offered to all patient as there is no skills to perform it except two had tried but un fortunally they went to continuoselly in labour. Almost cases assessed by assist lecture and managed by resident. All cases were counseled for C.S. As regard fetal out come till discharge all cases were alive except 4cases admitted to NICU, and 11 cases were IUFD, and 4 babies had congential anomalies.