Abstract
<p><strong>Objectives:</strong><strong> </strong>To determine fetomaternal outcome in patients undergoing planned vaginal breech delivery at term.</p><p><strong>Methods:</strong><strong> </strong>It was a descriptive cross sectional study conducted at Lady Aitchison hospital, Lahore for one and a half year from July 2012 to December 2013. All patients presenting with term breech presentation were included. Fetomaternal outcome in terms of successful vaginal delivery, maternal complications of operative delivery, PPH, wound infection and fetal complications of apgar score of less than five minutes, nursery admission, trauma during delivery (bone fracture, intra cranial hemorrhage) and perinatal mortality was studied.</p><p><strong>Results:</strong> 375 patients delivered as breech presentation during the study period. Out of 375 patients, 155 patients were selected for vaginal birth. Out of these, 65% had successful vaginal delivery, rest had emergency caesarean section due to fetal distress, cord prolapse dysfunctional labour. 6.4% patients had wound infection and 3.2% had PPH. Booking status was significantly important in patients who had successful vaginal delivery as 80% were booked (p = 0.001). There was no maternal mortality in these patients. Perinatal outcome was good in 87% of patients. 20 fetuses had Apgar score less than 7/min and required nursery admission. Two babies expired due to birth asphyxia and rest were discharged home in satisfactory condition.</p><p><strong>Conclusion:</strong><strong> </strong>Although delivery of breech remains a dilemma, the plan of delivery should be individualized. Proper selection of cases with proper antenatal and intrapartum care can result in successful breech vaginal delivery without compromising feto maternal wellbeing and curtailing the percentage of caesarean being done for this malpresentation.<strong></strong></p>
Highlights
IntroductionIn October 2000, the term breech trial was published in “The Lancet”[1], concluding that policy of planned caesarean section leads to better neonatal outcome as compared to vaginal births in breech
Booking status was significantly important in patients who had successful vaginal delivery as 80% were booked (p = 0.001)
In October 2000, the term breech trial was published in “The Lancet”[1], concluding that policy of planned caesarean section leads to better neonatal outcome as compared to vaginal births in breech
Summary
In October 2000, the term breech trial was published in “The Lancet”[1], concluding that policy of planned caesarean section leads to better neonatal outcome as compared to vaginal births in breech. Publication of the trial revolutionized the management of term breech deliveries. The number of caesarean section increased worldwide reaching to 80% at some places.[2,3,4] Guidelines from U.K5 and USA6 endorsed the policy of caesarean section for all term breech patients. The global reaction to trial has been exceptional because obstetricians face a dilemma when it comes to breech delivery especially in primigravida. The unintended result of this policy has been an increase in maternal mortality and morbidity especially in resource poor countries.[7,8] In addition, the obstetricians are losing skills of vaginal breech delivery safely. Many authors[9,10,11] have criticized term breech trial and expressed concerns
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