Maternal and neonatal outcomes of vaginal breech delivery for singleton term pregnancies in a carefully selected Cameroonian population: a cohort study

Abstract

Background and objectivesVaginal breech delivery (VBD) is known to be associated with more perinatal and maternal complications. Very few studies on the subject have been carried out in poor-resource settings. The aim of this study was to determine maternal and neonatal outcomes in carefully selected cases of VBD for singleton term pregnancies in a tertiary centre in Cameroon.DesignA retrospective cohort study.SettingA tertiary hospital in Yaounde, Cameroon.ParticipantsCases of VBD of newborns weighing 2500–3500 g were matched in a ratio of 1:4 to consecutive vaginal cephalic deliveries (VCDs) of newborns weighing 2500–3500 g over a 5-year period. Both groups were matched for maternal age and parity. We excluded cases of multiple gestations, footling breech, clinically inadequate maternal pelvis, preterm delivery, post-term pregnancies, fetal demise prior to the onset of labour, placenta praevia and fetal anomaly incompatible with vaginal delivery.Outcome measuresNeonatal and maternal adverse outcomes of VBD observed till 6 weeks after delivery analysed using Bonferroni correction.ResultsFifty-three (53) VBDs were matched against 212 VCD. Unlike women who had VCD, those who underwent VBD were more likely to have prolonged labour (OR 8.05; 95% CI 3.00 to 11.47; P<0.001), and their newborns were more likely to suffer from birth asphyxia (OR 10.24; 95% CI 4.92 to 21.31; P<0.001).ConclusionThe study infers a strong association between VBD of singleton term pregnancies and maternofetal morbidity when specific protocols are applied. This, however, failed to translate into higher differences in perinatal mortality. This finding does not discount the role of VBD in low-income countries, but we emphasise the need for specific precautions like close monitoring of labour and adequate anticipation for neonatal resuscitation in order to reduce these complications.

Maternal and Fetal Outcomes Following Labour at Term in Singleton Pregnancies with Meconium-Stained Amniotic Fluid: A Prospective Cohort Study

“…Although the exact cause of this MSAF is unclear, fetal distress, cord accidents and maternal hypertension have been identified as potential risk factors [9] [10]. Intrauterine emission of meconium has both fetal and neonatal consequences as well as maternal risks [5].…”

The incidence and perinatal outcomes of singleton vaginal breech deliveries in a low-resource setting, mpilo central hospital, Bulawayo, Zimbabwe

“…This shows that vaginal breech deliveries are associated with adverse fetal outcomes. 1,5,6 There were no major maternal complications.…”

“…In two studies in Sub-Saharan countries, there was a strong association between vaginal breech delivery of singleton term pregnancies and maternofetal morbidity, with newborns more likely to suffer from birth asphyxia. 5,6 In a Saudi Arabian study, there was higher neonatal mortality found in vaginal breech delivery for singleton preterm breech fetus. 7 Vaginal breech delivery is still a safe option without compromising maternal and neonatal outcome if strict criteria are met before and during labour.…”

Interactions between the Physical and Social Environments with Adverse Pregnancy Events Related to Placental Disorders—A Scoping Review

“…In some studies, occupation of the women could not be clearly defined as there could be combinations of occupations, for instance a housewife being unemployed, an entrepreneur or a peasant [18]. Parity was found to be associated with stillbirths, abruptio placentae, LBW, placental abnormalities, hypertension and eclampsia [14,16,[20][21][22]27,[31][32][33][34][35]. High parity presents as a risk factor due to the characteristics of multiparous women, which include high tendencies of performing unsupervised vaginal deliveries, not seeking antenatal care and their advanced age [22].…”