Outcome of breech delivery: caesarean section versus vaginal delivery at Patan Hospital, Patan Academy of Health Sciences

Abstract

Introductions:Obstetricians have long debated the role of caesarean section as a potentially safer mode of delivery for the fetus with breech presentation. However, the experience of the health care provider remains a critical element in the decision to pursue a vaginal breech delivery, and it may still be a viable option. The aim of this study is to determine the incidence of breech delivery at Patan Hospital and compare maternal and neonatal outcomes subjected to either vaginal or caesarean section. Methods:This was a five-year retrospective study of breech deliveries covering the year 2010 to 2014. Patient's charts were retrieved from the medical record section and reviewed.Results: There were 896 breech deliveries out of a total 44,842 deliveries giving an incidence of 1.99%. One hundred thirteen (12.61%) of breech deliveries were through vaginal route while 431 (48.10%) and 352 (39.28%) were through emergency and elective caesarean sections respectively. There were 154 (17.18%) preterm breech deliveries including 27 (17.5%) preterm intrauterine death. Among term pregnancy, there were 3 neonatal deaths not associated with mode of delivery. None of the term infant had neurological morbidity comprising neonatal seizures, brachial plexus injury, chephalohematoma. Maternal blood loss was significantly higher in caesarean section group. Conclusions:In well-selected cases, the neonatal outcome following assisted vaginal breech delivery and caesarean section may not be different.

Maternal and Perinatal Outcomes of Singleton Term Breech Vaginal Delivery at a Tertiary Care Center in Nepal: A Retrospective Analysis

“…Large population based studies are not available to quote the incidence of breech deliveries in our setup. Hospital-based studies conducted in different tertiary level hospitals have reported the breech delivery incidence of 1.9–2.5% [ 11 , 12 ], similar to the incidence reported in our study. But this is slightly lower than the overall incidence of 3–5% [ 1 ].…”

“…The higher rates of perinatal morbidity and mortality associated with vaginal breech deliveries in our study are not in compliance with results from other hospitals of Nepal [ 11 – 13 ]. This may be because of insufficient sample size in study—that those hospitals have lower numbers of total deliveries which allows them to allocate adequate human resources for the management of those cases.…”

“…Our analysis reported a very high perinatal mortality among vaginal breech deliveries compared to other studies [ 11 , 12 , 15 ]. Mortalities were higher among those with gestation more than 40 weeks, or among babies weighing less than 2500 grams as compared to those with birthweight ≥2500 grams (21.05% versus 4.62%; P =0.043).…”

Perinatal Outcomes of Singleton Breech Deliveries in a Tertiary Care Centre in Nepal

“…This study was aimed at determining the prevalence and perinatal outcomes of singleton breech delivery at a tertiary level hospital in Nepal. The prevalence of breech presentation in our study was higher than that reported by previous studies conducted in Nepal (1.9-3.1%), 10,13,14 but it was less than the prevalence reported in Ethiopia 5 and Malaysia. 6 Our centre is a tertiary level hospital where significantly large number of cases of high-risk pregnancy including abnormal presentations are referred in, which might be the reason for higher incidence of breech in comparison to previous national studies.…”

Perinatal Outcome of Vaginal Breech Delivery versus Caesarean Breech Delivery in a Tertiary Care Center

“…4 Another study in Patan Academy of Health Sciences concluded that in well-selected cases, the neonatal outcome following assisted vaginal breech delivery and caesarean section may not be different. 5 Adverse perinatal outcome in planned vaginal breech labor at term is associated with fetal growth restriction, oligohydramnios, previous cesarean delivery, gestational diabetes, nulliparity and epidural anesthesia. 6 Women intending vaginal delivery had higher rates of neonatal morbidity (6.0% vs 2.1%), neonatal birth trauma (7.4% vs 0.9%), Apgar <4 at one minute (10.5% vs 1.1%), Apgar <7 at five minutes (4.3% vs 0.5%) and neonatal intensive care unit/special care nursery admissions (16.2% vs 6.6%) than those planning caesarean section.…”