Maternal and perinatal outcome in term singleton breech presentation at term pregnancy
Keywords:Apgar, Breech, C-section, Post-partum hemorrhage, Term pregnancy
Background: Breech presentation is defined as a fetus in a longitudinal lie with the podalic at the pelvic brim. There are three types of breech presentations: frank breech, complete, incomplete breech. The incidence of breech presentation decreases from about 20% at 28 weeks of gestation to 3-4% at term, as most babies turn spontaneously to the cephalic presentation. Studies have shown that the prevalence of term breech presentation varies globally. In India the incidence was shown to be, 2.1%, and in other Asian countries it was found to be around 2.9 -4.5%. Its incidence is around 25% at 28 weeks of gestation and it reduces to 4% by term. If patients are carefully selected, breech presentation can be delivered vaginally. However, the risk of neonatal complications still persists. sometimes the planned vaginal delivery has to be converted into emergency cesarean section. Such probability varies from 17.4 to 51%.
Methods: This was a prospective observational study conducted in department of obstetrics and gynaecology department of SAMC and PGI, Indore, Madhya Pradesh from 1st April, 2021 to 31st October 2022. Ethical approval was taken from the institutional review committee. All term pregnant women (≥37 weeks) aged 18 years and above, admitted to the maternity and labor ward with the diagnosis of singleton breech presentation during the study period were included in the study. The patients were identified as having breech presentation on admission using physical examination and ultrasound. Those women who presented with antepartum hemorrhage, uterine rupture, fetuses with major congenital anomalies and intrauterine deaths were excluded from the study. After through exclusion sample of 70 people were included in study.
Results: During the study period, 896 deliveries were conducted in this hospital. Among them, 70 (7.86%) of the deliveries were singleton breech delivery. The age of the participants in the study ranged from 16 to 45 years, with a mean age of 27.07±8.56 years. Most of them had elective cesarean section, and few had emergency cesarean section. The most common indication for emergency cesarean section was footling presentation. Most of the new-borns were males, mean weight of new-borns 2.75±0.5 kg. 21.9% neonates required admission in neonatal intensive care unit, 2.8% mothers developed wound infection and 10% had post-partum haemorrhage.
Conclusions: Proper guidance, education and strict adherent to principles and steps of breech delivery, like monitoring taking up call for emergency c-sections, having proper NICU setup, trained doctors will help in reduction of complications. A protocol for the management of breech delivery and a regular training facility for junior health professionals to conduct assisted vaginal breech delivery are highly recommended.
Niles KM, Barrett JFR, Ladhani NNN. Comparison of cesarean versus vaginal delivery of extremely preterm gestations in breech presentation: retrospective cohort study. J Matern Fet Neonat Med. 2019;32(7):1142-7.
Daftary S, Chakravarti S. Manual of Obstetrics. 4th edn. New Delhi, India: Elsevier publications; 2003:229-235.
Koo MR, Dekker GA, van Geijn HP. Perinatal outcome of singleton term breech deliveries. Eur J Obstet Gynecol Reprod Biol. 1998;78(1):19-24.
Roman H, Carayol M, Watier L, Le Ray C, Breart G, Goffinet F. Planned vaginal delivery of fetuses in breech presentation at term: prenatal determinants predictive of elevated risk of cesarean delivery during labor. Eur J Obstet Gynecol Reprod Biol. 2008;138(1):14-22.
Assefa F, Girma W, Woldie M, Getachew B. Birth outcomes of singleton term breech deliveries in Jimma University Medical Center, Southwest Ethiopia. BMC Res Notes. 2019;12(1):428.
Ngowa JDK, Kasia JM, Ekotarh A, Nzedjom C. Neonatal outcome of term breech births: a 15-year review at the Yaoundé General Hospital, Cameroon. Clin Mother Child Health. 2012;9(1).
Ojiyi EE, Dike EI, Okeudo C, Anolue FC, Uzoma O, Uzoma MJ, et al. Outcome of singleton term breech deliveries at a University Teaching Hospital in Eastern Nigeria. WebmedCentral Obstet Gynaecol. 2011;2(12):WMC002543.
Mekbib TA. Breech delivery and foetal outcome: a review of 291 cases. Ethiop Med J. 1995;33(3):175-82.
Rauf B, Ayub T. Maternal and perinatal outcome in term singleton breech presentation. J Postgrad Med Inst Peshawar-Pak. 2004;18(3).
Hickok DE, Gordon DC, Milberg JA, Williams MA, Daling JR. The frequency of breech presentation by gestational age at birth: a large population-based study. Am J Obstet Gynecol. 1992;166(3):851-2.
Singh A, Mishra N, Dewangan R. Delivery in breech presentation: the decision making. J Obstet Gynaecol India. 2012;62(4):401-5.
Berhan Y, Haileamlak A. The risks of planned vaginal breech delivery versus planned caesarean section for term breech birth: a meta- analysis including observational studies. BJOG Int J Obstet Gynaecol. 2016;123(1):49-57.
Weiner CP. Vaginal breech delivery in the 1990s. Clin Obstet Gynecol. 1992 Sep;35 (3):559-69.
Albrechtsen S, Rasmussen S, Dalaker K, Irgens LM. Perinatal mortality in breech presentation sibships. Obstet Gynecol. 1998;92(5):775-80.
Burgos J, Rodríguez L, Cobos P, Osuna C, Del Mar Centeno M, Larrieta R, et al. Management of breech presentation at term: a retrospective cohort study of 10 years of experience. J Perinatol. 2015;35(10):803-8.