Breech delivery: changing scenario

Sanjivani Anil Wanjari

Abstract


Background: In context of the debate surrounding the optimal mode of delivery for the breech, we did a retrospective study in our hospital. The aim of the study was to assess the mode of delivery, to analyze the indications for caesarean section and to find out the perinatal outcome in breech during the study period.  

Methods: A retrospective study was done of women with breech admitted to our unit at Daga hospital Nagpur. All women having viable breech pregnancies of more than 34 weeks gestation were included in the study. An effort was done to find out whether mode of delivery affected neonatal outcome.  

Results: Although it is not our policy to have an elective planned caesarean section for all breech presentations, there was a high rate of caesarean section for breech. Most of the caesarean sections were in primigravida having a breech presentation (58.62%). Nearly 92 % of women in the study group were in the age group of 20 to 30 years. A high caesarean section rate in a young population can have implications in future pregnancies.  

Conclusions: There is an on-going debate about the best way to deliver breeches. The policy of planned caesarean section for breech may not be feasible in all hospitals and by choice or default, vaginal breech births will continue to take place, which means attention is still warranted to skills and techniques that may improve outcomes for the baby.

Keywords


Vaginal breech delivery, Caesarean section, Perinatal mortality

Full Text:

PDF

References


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;166:851-2.

Cheng M, Hannah M. Breech delivery at term: a critical review of the literature. Obstet Gynecol. 1993;82:605-18.

Ref-Hannah ME, Hannah WJ, Hewson SA, Hodnett ED, Saigal S, Willan AR. Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Term Breech Trial Collaborative Group. Lancet. 2000;356:1375-83.

Gifford DS, Morton SC, Fiske M, Kahn K. A meta-analysis of infant outcomes after breech delivery. Obstet Gynecol. 1995;85:1047-54.

Gini Njoku O. The outcome of breech delivery. Trop J Obstet Gynaecol. 1987;8(2):15-8.

Myers SA, Gleicher N. Breech delivery: why the dilemma? Am J Obstet Gyanecol. 1980;137:235.

Danielian P, Wang J, Hall M. Long-term outcome by method of delivery of foetuses in the breech presentation at term: population-based follow-up. BMJ. 1996;312:1451-3.

Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Menacker F, Munson ML. Births: final data for 2002. Natl Vital Stat Rep. 2003;52(10):11-3.

Rietberg CC, Elferink-Stinkens PM, Visser GH. The effect of the Term Breech Trial on medical intervention behaviour and neonatal outcome in The Netherlands: an analysis of 35 453 term breech infants. BJOG. 2005;112:205-9.

Goffinet F, Carayol M, Foidart JM, Alexander S, Uzan S, Subtil D, et al. PREMODA Study Group. Is planned vaginal delivery for breech presentation at term still an option? Results of an observational prospective survey in France and Belgium. Am J Obstet Gynecol. 2006;194:1002-11.

Lavin JP Jr, Eaton J, Hopkins M. Teaching vaginal breech delivery and external cephalic version. A survey of faculty attitudes. J Reprod Med. 2000;45:808-12.

American College of Obstetricians and Gynaecologists. ACOG Committee Opinion No. 340. Mode of term singleton breech delivery. Obstet Gynecol. 2006;108:235-7.