Childbirth with fetal pelvis presentatio: Challenge in modern obstetrics

Abstract

The aim was to determine the incidence of fetal breech presentation at term, the factors that determine how the impact of labor and mode of delivery on neonatal outcome in pregnancies with a fetus in breech presentation pelvic presentation is a form of the longitudinal position of the fetus, which leads the pelvis and occurs in approximately 3% of pregnancies. Numerous studies have shown contradictory results regarding the optimal mode of delivery in breech presentation of fetus. A retrospective study at the Hospital of Gynecology and Obstetrics, University Hospital Zemun-Belgrade in the period 01.01.2009-31.12.2011 year. We analyzed data obtained from the delivery protocol, computer databases and annual reports. Study involved 111 pregnant women in the forward singleton pregnancy (37-41 weeks gestation) with fetal pelvis. We analyzed and compared the group of patients who delivered their babies vaginally and the group of patients who delivered their babies by caesarean section (emergency and planned). Analyzed and compared the following parameters: maternal age, parity, gestational age trudnoće, premature rupture of membranes, weight and head circumference fetus at birth, Apgar score and neonatal complications. The data were analyzed by descriptive and analytical statistics. Results are presented tables and graphs. The study period was performed 4665 deliveries, with 111 deliveries in futures fetuses in breech presentation, which is 2.4%. Women delivered vaginally was 79(71%), emergency caesarean section 17(15%), a planned caesarean section 15(14%) pregnant women. The study showed a statistically significant difference in parity (C2=6.23 p<0, 05), with greater participation in the group of primiparas cesarean section, gestational age (t=5.23 p<0,01), weight and head circumference (t=4.37, t=2.47 p<0,01), premature rupture of membranes, (C2=7.72 p<0,01) and gender structure (C2=4.03 p<0,05). The most common indication for elective Caesarean section was prolonged pregnancy, and for an emergency cesarean section because of the delivery routes. There was no statistically significant difference in age of the mother t=1.08, p>0,05, the values of Apgar score in 5 minutes t=1.67 p>0,05, neurological changes p=0.292 and birth trauma, p=0.292 between two groups of neonates. The values of ul minute Apgar score were at the limits of statistical significance p=1.97 p≥0.05. Vaginal delivery in breech presentation, fetal, obstetric an acceptable range, while respecting the principles of good obstetric practice, there is no increase in neonatal morbidity.