Maternal and Perinatal Outcomes of Singleton Term Breech Vaginal Delivery at a Tertiary Care Center in Nepal: A Retrospective Analysis

Abstract

Background. Breech presentation is associated with increased rates of maternal and perinatal morbidity regardless of mode of delivery. After the results of Term Breech Trial, most of the countries adopted the protocol of cesarean section for term breech delivery because of which breech vaginal delivery is becoming rare. The aim of this study is to evaluate short-term maternal and perinatal outcomes of breech vaginal delivery at a tertiary care hospital in Nepal. Methods. A retrospective review of case records of all women who had vaginal breech delivery from April 13, 2016, to April 12, 2018, was conducted, over a period of two years. Available demographic variables, obstetric characteristics, details of labor, postpartum complications, and perinatal complications were recorded and analyzed. Results. Out of 21,768 cases of deliveries during the study period, the incidence of term breech deliveries was 528 (2.4%) among which the mode of only 84 (17.8%) deliveries was vaginal. Most of the deliveries were unplanned and were conducted because emergency cesarean section could not be performed. Three (3.6%) women had postpartum hemorrhage, and four (4.8%) had entrapment of aftercoming head, two of them requiring Dührssen incisions. Adverse perinatal outcomes were seen in 23.8% of such deliveries with <7 APGAR score at 5 minutes in 20.2%, neonatal admission in 17.7%, and perinatal mortality in 8.3%. The perinatal mortality was significantly associated with birthweight less than 2500 grams as compared to birthweight ≥2500 grams (21.1% versus 4.6%; P = 0.043 ). Conclusion. The perinatal outcomes for vaginal breech delivery are grave with our existing health facilities, especially when the deliveries are not well planned.

Perinatal Outcomes of Singleton Breech Deliveries in a Tertiary Care Centre in Nepal

“…This study was aimed at determining the prevalence and perinatal outcomes of singleton breech delivery at a tertiary level hospital in Nepal. The prevalence of breech presentation in our study was higher than that reported by previous studies conducted in Nepal (1.9-3.1%), 10,13,14 but it was less than the prevalence reported in Ethiopia 5 and Malaysia. 6 Our centre is a tertiary level hospital where significantly large number of cases of high-risk pregnancy including abnormal presentations are referred in, which might be the reason for higher incidence of breech in comparison to previous national studies.…”

“…A recent study on breech presentation had reported a prevalence of 2.4% in Nepal. 10 Considering the same prevalence as our expected frequency and with 95% confidence level and 2% margin of error; sample size was calculated to be 225 from openepi.com, open source software for epidemiologic statistics. However, 226 pregnant women were enrolled in the study.…”

“…8,9 A recent study in Nepal revealed the incidence of singleton breech to be 2.4%. 10 Breech presentation is associated with increased rates of maternal and perinatal morbidity regardless of modes of delivery. 10,11 A 10-fold higher risk of intrapartum fetal death is found to be associated with vaginal breech delivery in comparison to caesarean delivery.…”

“…10 Breech presentation is associated with increased rates of maternal and perinatal morbidity regardless of modes of delivery. 10,11 A 10-fold higher risk of intrapartum fetal death is found to be associated with vaginal breech delivery in comparison to caesarean delivery. 12 The aim of this study was to explore the prevalence and perinatal outcomes of singleton breech delivery at Chitwan Medical College, a tertiary level hospital in Nepal.…”

Outcomes of Vertex-Vertex vs. Vertex-Breech Presentation in Twin Pregnancy after Vaginal Delivery

“…There was a view that vertex-breech presentation was attributed to an earlier gestational age. An alternative view was that breech presentation caused uterine overdistention, leading to premature rupture of membranes [29].…”