Breech delivery and foetal outcome: a review of 291 cases.

ABSTRACT

PIP: 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.