Breech delivery at a University Hospital in Tanzania

Högberg, Ulf; Claeson, Catrin; Krebs, Lone; Svanberg, Agneta Skoog; Kidanto, Hussein

doi:10.1186/s12884-016-1136-0

Cited by 11 publications

(24 citation statements)

References 24 publications

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“…Multiple authors have suggested that planned cesarean delivery may not be the best option in low‐income countries . Limited retrospective studies of mode of delivery in breech presentation in low‐income countries in sub‐Saharan Africa, primarily conducted at urban referral hospitals, have had conflicting results, but the majority of the studies demonstrate an increased perinatal risk with vaginal delivery . However, the rate of cesarean delivery for malpresentation at African study sites in the Global Network, which represent primarily non‐urban, non‐referral healthcare facilities, was low and increased only modestly over the study period.…”

Section: Discussionmentioning

confidence: 99%

Malpresentation in low‐ and middle‐income countries: Associations with perinatal and maternal outcomes in the Global Network

Duffy

Moore

Saleem

et al. 2018

Acta Obstet Gynecol Scand

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Introduction: Uncertainty exists regarding the impact of malpresentation on pregnancy outcomes and the optimal mode of delivery in low-and middle-income countries. We sought to compare outcomes between cephalic and non-cephalic pregnancies.Material and methods: Using the NICHD Global Network's prospective, populationbased registry of pregnancy outcomes from 2010 to 2016, we studied outcomes in 436 112 singleton pregnancies. Robust Poisson regressions were used to estimate | 301 DUFFY et al. | INTRODUC TI ONBreech presentation and other less common malpresentations affect up to 3%-4% of pregnancies at term and are even more common at earlier gestation. 1 Risk factors for malpresentation are diverse and include maternal age, parity, uterine anomalies, prematurity, fetal growth restriction, fetal anomalies and amniotic fluid abnormalities. Questions exist regarding the independent impact of malpresentation, especially breech presentation, on fetal and neonatal outcomes, 2,3 and much attention has been given to the best mode of delivery for these pregnancies.Following publication of the multi-country Term Breech Trial, which showed decreased neonatal morbidity and mortality with planned cesarean delivery compared with planned vaginal delivery for term breech presentations, 4 most high-income countries have adopted cesarean as the preferred mode of delivery for breech presentation. 5 Subsequent meta-analyses of additional studies examining mode of delivery have likewise shown an increase in neonatal morbidity and mortality with planned vaginal delivery compared with cesarean for breech presentation, although the absolute risk remains low. 5,6 In low-and middle-income countries (LMIC), there is even more uncertainty as to the significance of malpresentation for pregnancy outcomes, and controversy exists over the optimal management of pregnancies affected by malpresentation. 7,8 Several factors may influence outcomes. For one, the risk of neonatal morbidity and mortality and stillbirth is often greater in LMIC than in high-income countries. Cesarean delivery is also less available in many LMIC settings and may not be uniformly accessible, competently practiced or routinely performed for breech presentations. 9 Furthermore, there is heightened concern over the increased maternal risk associated with operative delivery in these settings. 10Given this knowledge gap, we sought to compare fetal, neonatal and maternal outcomes between cephalic and non-cephalic pregnancies in LMIC, to examine rates of cesarean delivery for malpresentation and to explore the association between mode of delivery and fetal, neonatal and maternal outcomes. | MATERIAL AND ME THODS Using the Global Network for Women's and Children's HealthResearch's prospective, multi-country, population-based maternalnewborn registry of pregnancy outcomes from 2010 to 2016, we analyzed outcomes by presentation and mode of delivery in singleton pregnancies. The Global Network's Maternal and Newborn Health Registry (MNHR) is funded by the Eunice Kennedy Shriver Natio...

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Section: Discussionmentioning

confidence: 99%

Malpresentation in low‐ and middle‐income countries: Associations with perinatal and maternal outcomes in the Global Network

Duffy

Moore

Saleem

et al. 2018

Acta Obstet Gynecol Scand

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“…This shows that vaginal breech deliveries are associated with adverse fetal outcomes. 1,5,6 There were no major maternal complications.…”

Section: Discussionmentioning

confidence: 89%

“…In two studies in Sub-Saharan countries, there was a strong association between vaginal breech delivery of singleton term pregnancies and maternofetal morbidity, with newborns more likely to suffer from birth asphyxia. 5,6 In a Saudi Arabian study, there was higher neonatal mortality found in vaginal breech delivery for singleton preterm breech fetus. 7 Vaginal breech delivery is still a safe option without compromising maternal and neonatal outcome if strict criteria are met before and during labour.…”

Section: Introductionmentioning

confidence: 99%

The incidence and perinatal outcomes of singleton vaginal breech deliveries in a low-resource setting, mpilo central hospital, Bulawayo, Zimbabwe

Ngwenya¹

2019

MOJWH

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Background: Vaginal breech deliveries are becoming less and less in obstetric units since the publication of the Term Breech Trial in 2000. There are less and less training opportunities for trainees in the specialty. Simulation training could never be as good as having real experience of vaginal breech deliveries. Consequently, many clinicians are now less confident in dealing with vaginal breech deliveries. The objective of this study was to document the incidence and perinatal outcomes of singleton vaginal breech deliveries in a low-resource setting. Methods: This was a retrospective descriptive study covering the period between 1 January 2017 and 31 December 2017 in a tertiary teaching hospital. A paper data collection sheet was used to collect the information. All singleton babies >24 weeks gestation born by vaginal breech delivery at the labour ward were included in the study. The data was then analysed. Results: The incidence of singleton vaginal breech deliveries 0.66%. Teenage mothers accounted for 10.7%. 21.4% of women were unbooked. 76.8% were live deliveries and 23.2% were stillborn, and there was a statistical difference between the two groups, P=0.05. Of the live births, 51.2% had 1 minute Apgar score of <7. By 5 minute 32.6% still had Apgars scores <7. 98.2% of mothers had no complications post delivery, with only 1 case of PPH, P=0.025. Conclusions: The incidence of all singleton vaginal breech deliveries 0.66% and only 0.05% for term breech. Of the live births, more than half had low 1 minute Apgar score of <7. The vast majority mothers had no complications post-delivery.

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“…The increased likelihood of cesarean delivery among nulliparous breech term pregnancies (Robson group 6) after CBA, was associated with an increase in the relative size of the respective group. This was because cesarean delivery was mandatory based on the local and international evidence of severe perinatal morbidity associated with vaginal breech delivery; and also there was lack of accessible clinical guidelines for safe breech delivery at MNH. Nonetheless, training care providers on external cephalic version (ECV) promotes its use and reduces unnecessary primary cesarean delivery .…”

Section: Discussionmentioning

confidence: 99%

“…The increased likelihood of cesarean delivery among nulliparous breech term pregnancies (Robson group 6) after CBA, was associated with an increase in the relative size of the respective group. This was because cesarean delivery was mandatory based on the local 16 and skin-to-skin (Kangaroo) mother care. 20 However, preterm pregnancies received at MNH tend to include cases with other complications such as premature rupture of membranes, antepartum hemorrhage, pre-eclampsia, or eclampsia; hence, there is an increased likelihood of preterm cesarean delivery and adverse perinatal outcomes.…”

Section: Discussionmentioning

confidence: 99%

Use of a criteria‐based audit to optimize uptake of cesarean delivery in a low‐resource setting

Mgaya

Kidanto

Nyström

et al. 2018

Intl J Gynecology & Obste

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Objective To evaluate the impact of a criteria‐based audit (CBA) of obstructed labor and fetal distress on cesarean delivery and perinatal outcomes. Methods A cross‐sectional study was performed at a tertiary referral hospital in Tanzania. Data were collected before and after CBA (January 2013–November 2013 and July 2015–June 2016). Outcomes of fetal distress (baseline CBA, n=248; re‐audit, n=251) and obstructed labor (baseline CBA, n=260; re‐audit n=250) were assessed using a checklist. Additionally, 27 960 parturients were assessed using the Robson classification. Results Perinatal morbidity and mortality decreased from 42 of 260 (16.2%) to 22 of 250 (8.8%) among patients with obstructed labor after CBA (P=0.012). Cesarean delivery rate decreased for referred term multiparas with induced labor or prelabor cesarean delivery (odds ratio [OR] 0.28, 95% confidence interval [CI] 0.09–0.82). Cesarean delivery rate for preterm pregnancies increased among both referred (OR 1.28, 95% CI 1.02–1.63) and non‐referred (OR 2.78, 95% CI 1.98–3.90) groups. Neonatal distress rate decreased for referred term multiparas (OR 0.72, 95% CI 0.56–0.92), referred preterm pregnancies (OR 0.32, 95% CI 0.25–0.39), and non‐referred preterm pregnancies (OR 0.26, 95% CI 0.18–0.36). Conclusion Use of CBA reduced poor perinatal outcomes of obstructed labor and increased uptake of cesarean delivery.

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Breech delivery at a University Hospital in Tanzania

Cited by 11 publications

References 24 publications

Malpresentation in low‐ and middle‐income countries: Associations with perinatal and maternal outcomes in the Global Network

Malpresentation in low‐ and middle‐income countries: Associations with perinatal and maternal outcomes in the Global Network

The incidence and perinatal outcomes of singleton vaginal breech deliveries in a low-resource setting, mpilo central hospital, Bulawayo, Zimbabwe

Use of a criteria‐based audit to optimize uptake of cesarean delivery in a low‐resource setting

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