Breech Presentation: Determinants of the Delivery Route and Neonatal Prognosis at the University Hospital Center of Brazzaville (Republic of Congo)

Abstract

Objective. To analyze the determinants of the delivery route and the neonatal prognosis in case of breech presentation at the University Hospital Center of Brazzaville. Method. Monocentric analytical cross-sectional study conducted from January 1 to December 31, 2019 in the Obstetrics Gynecology Department of the University Hospital Center of Brazzaville, comparing 54 women who gave birth by cesarean section and 23 women who gave birth vaginally. Were included all women who gave birth to a fetus in breech presentation whose chronological age was greater than or equal to 28 weeks of amenorrhea or a birth weight greater than 1000 g and their newborn. The variables studied were pre, per and post partal. The p-value of the probability was considered significant for a value less than 0.05. Results. Breech delivery represented 1.6% of deliveries, i.e. 97 out of 6075. The women delivered were not different in age [29 (24-34) vs 29 (26-33), p>0.05] nor in parity [1 (0-3) vs 2 (0-3), p>0.05]. Most of them gave birth by caesarean section (63.9% vs 36.1%). The determinants of the delivery route were: level of education (48.1% vs 73.9%; OR=3.1 [1.04-8.9]; p<0.05), gestational age less than 34 WA (0% vs 13%; p<0.05), the existence of a uterine scar (22.2% vs 0%; p<0.05) and insufficient fundal height (3.7% vs 26.1%; OR=0.12 [0.02 – 0.7]; p<0.05). Neonatal morbidity was not influenced by the route of delivery. Newborns from the vaginal route were the most transferred to neonatology (5.6% vs 34.8%; OR=0.11 [0.3 – 0.47]; p<0.05) and died (0% vs. 17.4%; p<0.05). Conclusion. The decision of the way of delivery in case of breech presentation at the University Hospital of Brazzaville depends on both maternal and obstetrical factors. Identifying the determinants requires careful questioning and rigorous obstetrical examination.