Outcome of singleton term breech cases in the pretext of mode of delivery.J Pak Med Assoc. 2000 Mar; 50(3):81-5.JP
A study was carried out to ascertain maternal and perinatal outcome of cases presented as breech versus their mode of delivery so that appropriate management strategy could be mapped out without compromising fetomaternal wellbeing.
The study was carried out in one of the units of the Department of Obstetrics and Gynaecology of Sir Ganga Ram Hospital, affiliated with Fatima Jinnah Medical College, from August, 1996 to July, 1999. Management of 352 singleton term breech cases was analyzed. Data gathered were socio-demographic variables, detailed obstetrical history, important features of index pregnancy, type of breech presentation, selection of mode of delivery and reason for choosing a particular route of delivery, indications of elective or emergency caesarean sections in the cases applicable, fetal outcome and maternal complications.
In 135 (38%) patients C-section (94 elective and 41 emergency) was done straightaway and trial of vaginal breech delivery was given to the remaining 217 (62%). Of these vaginal delivery could be done in 161 (74%) cases and 56 (26%) required caesarean section due to fetal distress and or failure to progress. About 32% primiparas could manage vaginally 55% multiparas while the ratio of caesareans done in both the groups was 68% vs 45%. A direct proportion was observed between C-section rate and neonatal birthweight. Route of delivery did not influence significantly neonatal outcome which become evident when no marked difference could be detected in corrected neonatal mortality rates calculated for the groups having elective C-section, emergency section and vaginal delivery. Perinatal mortality rate and corrected neonatal mortality rate of the study population and the same values computed for all the deliveries conducted during the study period were found to comparable. Maternal and neonatal complications were seen more frequently in the group requiring emergency caesarean section.
Proper selection of cases for vaginal delivery, vigilant intrapartum monitoring and employing proper technique of breech delivery have been established as the most important determinants for successful vaginal breech delivery without compromising fetomaternal well being and curtailing the percentage of caesareans being done for this malpresentation.