Audit of Singleton Breech Delivery in a Tertiary Hospital

Abstract

Background: The 2000 Term Breech Trial (TBT) demonstrated that planned caesarean section was safer for the 3-4% of pregnancies in which the fetus will be in the breech presentation at term. However, the approach to delivery has been a topic of interesting debate and heated controversy among obstetricians. Objectives: The aim of this study was to find out the incidence and perinatal outcome of singleton breech delivery at the University of Abuja Teaching Hospital, Abuja, and North-Central Nigeria. Methodology: This was a retrospective study of singleton breech deliveries managed at the University of Abuja Teaching Hospital between 1st January 2015 to 31st December 2019. Data on social-demographic characteristics, presentation, mode of delivery and neonatal outcome were obtained from the case notes retrieved from the Medical health information Department. Result: There were 287 singleton breech deliveries out of 10416 deliveries during the study period given an incidence rate of 2.8%. Majority of the women 265 (92%) were between 21-40 years with a mean age of 30.27 +/-5.66 years. There were 144 (50.2%) unbooked patients. Majority of the women 188 (65.5%) were multipara. About 108 (37.6%) of the babies were delivered as preterm. Assisted breech deliveries was conducted in 162 (56.44%) while 125 (43.55%) were via caesarean section with a caesarean section rate of 43.55%. The commonest indication for caesarean section was Breech plus previous uterine scar in 36 (28.8%). About 28 (9.8%) babies were born with low APGAR scores and had severe birth asphyxia. Majority of the babies, 23 (8.1%) delivered through assisted breech delivery suffered severe birth asphyxia compared to 3 (1.0%) babies who were delivered via caesarean section. Significant association was noted between route of delivery and perinatal outcome. Again, 77 (27.8) primigravidae had breech delivery in this study. About 9 (3.1%) babies delivered to these primigravidae had poor APGAR scores and suffered severe birth asphyxia. However, 8 (2.8%) babies were delivered through assisted vaginal delivery compared to 1 (0.3%) baby who was delivered through caesarean section. The test showed a significant association in perinatal outcome in primigravidae who were allowed to have assisted breech delivery with Chi-Square value of 50.551, df =2 and p-value of 0.0002 which is less than the significant level of 0.05. There were 41 perinatal deaths given a perinatal mortality rate of 143/1000. It was noted that 10 (3.5%) babies had intrauterine fetal death before delivery, while 31 (10.8%) occurred as fresh stillbirth and early neonatal death. About 26 (9.1%) of the perinatal were through assisted breech delivery and 5 (1.7%) were through caesarean section. The mean birth weight was 2.6 +/- 0.92 years. Maternal morbidities were associated with mothers who had caesarean section, this however was not significant. Conclusion: Breech delivery was common and was associated with high perinatal morbidity and mortality. Route of delivery has significant association with perinatal outcome. Careful case selection and skillful delivery protocol would ensure optimal perinatal outcome that will in turn reduce caesarean section rate and reduce the morbidities associated with caesarean section.