Preterm breech delivery in a developing country

Abstract

OBJECTIVES: To determine if cesarean section offers any advantage over vaginal delivery for a preterm breech fetus in a developing country. METHODS: A retrospective analysis from hospital records was done at a tertiary care center in North India. Two hundred and twenty-four preterm breech deliveries (28–36 completed weeks) between January 1988 and December 1991 from a total of 13 149 deliveries at the hospital during this period formed the study group. Fetal death and lethal congenital malformations diagnosed antepartum were excluded. Intrapartum and neonatal morbidity and mortality in vaginal versus cesarean deliveries were the main outcome measures. RESULTS: Although the combined intrapartum and neonatal mortality was significantly higher for vaginal delivery (35.9% vs. 17.7%), there was no significant difference when the data was correlated with birthweight or gestational age. The neonatal morbidity was also similar in both these groups. In women with a poor obstetric history, the neonatal survival was better in the cesarean group (93% vs. 43%; P = 0.0004). CONCLUSION: Even with optimum neonatal care facilities, cesarean section does not offer any advantage over vaginal delivery for a preterm breech fetus in a developing country. The present study does not advocate the routine use of cesarean section for this group of fetuses. However, it is the preferred route of delivery for women with a poor obstetric history.