A 5-year retrospective review of singleton term breech deliveries seen at a tertiary hospital in northern Nigeria

Abstract

Background: Most singleton breech deliveries in the developing countries are unplanned and therefore, associated with poor perinatal outcome. This is because despite high antenatal attendance, most patients present in advanced labour, coupled with inadequate work force and skill attendants for the management of such cases. This study was undertaken to determine the incidence and outcome of term singleton breech deliveries at the University of Maiduguri Teaching Hospital (UMTH). Patients and Methods: This is a retrospective study of term singleton breech deliveries at the UMTH, a tertiary health facility in northeastern Nigeria over 5 years from January 1, 2003 to December 31, 2007. The delivery and theater records for all singleton breech deliveries at term were collected while the case notes were retrieved from the central medical records department. Information on age, parity, booking status, type of breech, level of skill of the attendant (accoucheur), Apgar scores, and birth weight were extracted. The main outcome measures were still births, low Apgar scores, birth weight, and accoucheur. Data were analyzed using Statistical Package for the Social Sciences (SPSS) 16.0 statistical computer package. Results: There were 173 term singleton breech deliveries among the 10,203 patients who delivered during the study period, giving an institutional incidence of 1.69%. The age of the patients ranged 18-44 years; 51.9% of the patients were aged 25-34 years. The likelihood of breech presentation at term increased with increasing parity, being 25.5% among nulliparae, 34.4% in women with 2-4 children, and 40.1% in women who had delivered 5 or more children ( P = 0.001). Extended or Frank breech was the most common type of breech presentation, accounting for 54.8%. Most patients (80.3%) were booked. 52.2% were delivered by cesarean section (CS). Only 30.6% of the deliveries were planned despite the large proportion of booked patients in the study. There were 147 live births and two fresh stillbirths. Senior obstetricians or senior midwives were involved in the conduct of almost all the live births. The only two fresh still births resulted from the junior registrars' delivery. Birth asphyxia — Apgar score of less than 6-was more common in the unplanned group than in the planned group ( P = 0.01), and all instances were found in the patients delivered by junior registrars. Conclusion: Despite the high antenatal attendance in the study group, breech deliveries were largely unplanned and the fetal outcome was directly related to the level of skill of the accoucheur. There is a need to plan and have skilled and senior obstetricians in attendance at delivery for this high-risk group.