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  • Title: Breech delivery and foetal outcome: a review of 291 cases.
    Author: Mekbib TA.
    Journal: Ethiop Med J; 1995 Jul; 33(3):175-82. PubMed ID: 7588656.
    Abstract:
    In a three year period (September 1989 to August 1992), among 7,170 consecutive deliveries at Yekatit 12 Hospital, Addis Abeba, Ethiopia, there were 291 singleton breech deliveries with a 4% incidence rate at a gestational age of 28 weeks and above. In 28% and 57% of the infants, weight was below 2,500 grams and Apgar score was less than 7 in the first minute, respectively. The gross perinatal mortality rate for breech delivery in the first 24 hours was 330 per 1,000 deliveries, which was significantly higher than for the total number of deliveries (70 per 1,000; p < 0.001). However, the perinatal mortality rate was 1,000 per 1,000 deliveries for foetuses of less than 1,500 grams, 635 for foetuses between 1,500-2,500 grams, and 156 for foetuses of greater than 2,500 gm. In general, foetuses with low birth weight showed a high mortality rate (p < 0.001). There was also a two-fold increase in perinatal death in patients without antenatal care (p < 0.001). In order to reduce this unacceptably high perinatal mortality, emphasis must be given to appropriate training of physicians and midwives in the management of breech deliveries along with provisions of efficient prenatal care to improve birth weight. In addition, as most of the neonatal problems are preventable, measures need to be taken to establish neonatal units equipped with basic resuscitation materials and manpower. An obstetrician-gynecologist retrospectively reviewed the delivery records of 291 singleton breech presentations (BP) that occurred during September 1989-August 1992 at Yekatit 12 Hospital in Addis Ababa, Ethiopia, to examine birth outcomes. The singleton breech delivery rate was 4%. 57% of the BP infants had a one-minute Apgar score of less than 7. These infants comprised the majority of perinatal deaths. Perinatal death was more common among the low birth weight BP infants than those weighing 2500 g (707 vs. 156/1000; p 0.001). The perinatal mortality rate (PMR) increased as the birth weight decreased (2500 g, 156; 1500-2500 g, 635; and 1500 g, 1000). Mothers of BP infants who did not receive prenatal care were more likely to experience perinatal loss than those who received prenatal care (427 vs. 216; p 0.0001). 70% of perinatal deaths among those not receiving prenatal care occurred to infants weighing no more than 2500 g. 4.8% of cesarean sections had BP as an indication for cesarean section without maternal death. Since the hospital is a big referral hospital, many women came to the hospital in established and prolonged labor, which contributed to fetal death. The lack of a neonatal unit equipped with basic resuscitation equipment and health personnel further exacerbated the chances of infant survival. Establishment of such a unit and appropriate training of physicians and midwives in the management of breech deliveries will likely contribute to better fetal outcomes.
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