Foeto-Maternal Outcome between Vaginal Delivery and Caesarean Section in Breech Presentation: A Comparative Prospective Study

Abstract

Background:The problem of high perinatal morbidity and mortality is a great challenge to obstetricians and neonatologists in the developing countries. Breech presentation which is one of the commonest malpresentations is a major cause of high morbidity and mortality. The optimum mode of delivery of breech in order to minimise the risk to both the mother and the baby still remains controversial. Aims & objectives: The current study was conducted to find out the associated factors for different modes of delivery in breech presentation and also to compare the maternal and perinatal outcome between vaginal delivery (VD) and Caesarean section (CS) for singleton term pregnancy with breech presentation. Methods: A prospective study was done during the period October 2011 to March 2013. All pregnant women with singleton breech presentation with gestational age > 37 weeks admitted at the department of Obstetrics and Gynaecology, Regional Institute of Medical Sciences (RIMS), Imphal were the study subjects. Those not willing to participate in the study, multiple pregnancy, preterm pregnancy, pregnancy with chronic illness, intra-uterine death, complicated pregnancy like ante-partum haemorrhage, pregnancy associated with gynaecological problems like fibroids, cervical polyps etc. and having history of any uterine surgery were excluded from the study. Socio-demographic details were obtained by using a pre-tested, semistructured interview schedule. This was followed by a detailed history-taking and a thorough clinical examination. Relevant routine and sophisticated laboratory investigations were also performed wherever indicated. The study-subjects were followed up until discharge from the department. Data were analysed by using SPSSv16.0. Result: The CS rate was found to significantly higher among booked women, nulliparous women, women not in labour at the time of admission, complete breech and women with a higher gestational age and baby's weight more than 3 kg. Clients' age, religion, prior stay and fundal localization at cornua, although seemed to be slightly higher among CS cases, the associations were not found to be statistically significant. Apgar scores at 1 and 5 min, necessity for admission in Neonatal Intensive Care Unit (NICU) and neonatal deaths were found to be significantly lower to those babies delivered by CS compared to those delivered by VD. But, regarding maternal outcome, post-delivery blood transfusion was found to be significantly more necessary for CS compared to that of VD. Conclusion: Vaginal delivery confers more benefit to the mother whereas CS increases safety to the newborn. Bigger studies are needed to determine whether a potential benefit for the newborns outweighs the increased risk for the mothers associated with caesarean section. Meanwhile, great care, skill and judgment have to be exercised on case-based approach to get the best results.