Incidence Of Breech Delivery Research Articles

Breech presentation - maternal and neonatal outcomes and obstetric challenges

Introduction/Objective. Breech presentation occurs in 3-4% singleton pregnancies at term and its management is still a controversial in obstetric practice. The aim of this study was to determine the factors that indicate breech delivery management and to compare maternal and neonatal outcomes in vaginal breech delivery, planned Cesarean section and emergency C-section at the Hospital for Gynecology and Obstetrics of the Zemun Clinical Hospital Centre. Methods. This was a retrospective study conducted from 2015 to 2019. Depending on the mode of delivery patients were divided in three group. In the study we have analyzed maternal risk factors and postpartum complications, delivery details and neonatal characteristics and outcomes. Results. Study included 176 women with singleton fetus in breech presentation. The incidence of breech deliveries was 2.12%. Most common way of delivery was vaginal with 47.72%. In all three groups the majority of women were primiparous, at term, mostly without chronical and gestational diseases. Vaginal delivery was stimulated with oxytocin in 91.67% and as a help for delivery various maneuvers were used. Maternal mortality and short-term complications during hospitalization period were not reported in none of the groups. No significant difference in newborns birth weight between the groups was observed. The highest rate of birth injuries was in newborns from emergency C-section - 10%. Conclusion. The results of our study have shown that vaginal delivery could be a very safe option for both mother and newborn.

Outcome of breech deliveries in Aminu Kano Teaching Hospital, Kano State, Nigeria: A 2-year study

Breech presentation is defined as polar alignment of fetus in which the fetal buttocks or feet present at the maternal pelvic inlet. Breech is the most common malpresentation in pregnancy, incidence is high before term but occur in 3-4% of term pregnancies. There is increased perinatal morbidity and mortality with breech presentation which has been linked to the prematurity, birth asphyxia due to cord accidents, congenital abnormalities, birth trauma and mode of delivery. This study was aimed at determining the incidence and outcome of breech deliveries at Aminu Kano Teaching Hospital, Nigeria. It was a retrospective analysis of breech deliveries at Aminu Kano Teaching Hospital over a 2-year period. Information was obtained from the labor ward register, theatre register and the case notes of the mothers. There were 6658 deliveries during the period of the study, out of which 154 had breech deliveries. The incidence of breech deliveries during the period under study was 2.31%. The age of the patients ranged from 17-45 years. Parity ranged between 0-11. There were more breech deliveries in the multipara (59.5%) than in primigravidae (14.9%) and primipara (25.6%).However, there was no significant difference in the perinatal outcome between the groups (P=0.054). Deliveries were mostly through caesarean section (62%), while 38% were through assisted vaginal breech. There were 113 live births and 8 still births. This study has shown that the incidence of breech is slightly lower than in many studies, and breech deliveries were mostly unplanned and more among multiparae. The neonatal outcomes in the planned breech deliveries were excellent. Birth asphyxia and stillborn were found more in the unplanned and unbooked cases with breech.

Incidence, risk factors, and adverse short term perinatal and maternal outcomes associated with singleton breech presentation at delivery in Northern Tanzania

ABSTRACTBackgroundBreech presentation has been associated with adverse perinatal and maternal outcomes. However, the incidence and associated perinatal and maternal outcomes has not been fully explored in Tanzania. This study aimed to determine the incidence, risk factors and adverse short term perinatal and maternal outcomes associated with singleton breech presentation at delivery at Kilimanjaro Christian Medical Centre (KCMC) hospital.MethodsThis was a retrospective study involving 47,626 singletons deliveries between 2000 and 2014, using maternally-linked KCMC Medical Birth Registry. Adjusted odds ratios (ORs) with 95% CI for risk factors and adverse short term perinatal and maternal outcomes were estimated using multiple logistic regression models. ResultsThere were a total 8761 women who had subsequent singleton deliveries during this study period. The incidence of breech delivery was 0.8%. Advanced maternal age (>30 years) (AOR 1.3 95% CI 1.1-1.6), delivery of low birth weight infant (AOR 3.4, 95% CI 2.8-4.1) and malformed child (AOR 8.0, 95% CI 3.6- 17.8) were associated with increased risk of breech delivery. Breech presentation was associated with an increased risk of delivering an infants with Apgar score of less than 7 at 5 minutes (AOR 4.6, 95% CI 3.7-5.6), low birth weight (AOR 3.5, 95% CI 2.9-4.3), congenital malformation (AOR 9.3, 95% CI 4.2-20.3) and perinatal death (AOR 6.3, 95% CI 5.1-7.9). Breech presentation was also associated with high risk of preeclampsia/eclampsia (AOR 1.6 95% CI 1.2-2.3) as compared to cephalic presentation. In addition, vaginal breech delivery increase women’s likelihood of delivering infant with Apgar score of less than 7 at 5 minutes (AOR 4.4, 95% CI 2.5-6.6), low birth weight (AOR 3.4, 95% CI 2.3-5.0) and perinatal death (AOR 5.1, 95% CI 3.1-8.4). ConclusionsBreech delivery was associated with adverse perinatal and maternal outcomes as compared to cephalic presentation. Vaginal breech delivery was associated with unfavorable perinatal and maternal outcomes as compared to cesarean breech delivery. Early identification of these risk factors and provision of appropriate management during delivery such as caesarian-section when needed may reduce the poor perinatal and maternal outcomes.

A study of labour outcome in breech delivery

Aim: Breech is the most common form of malpresentation. It is defined as when foetus occupies a longitudinal lie with the pelvic extremity at the pelvic brim and head at the fundus of the uterus. The present study was conducted on 100 cases of breech presentation to find out the labour outcome in breech deliveries and various factors affecting it. Materials and Methods: The present study was conducted in the Department of Obstetrics and Gynaecology, Umaid Hospital, attached to Dr. S.N. Medical College, Jodhpur. A total of 100 cases of breech presentation including single as well as plural pregnancies in which one or more foetuses were presenting as breech were taken. Both booked and unbooked cases in primigravidae and multigravidae were studied. The cases were selected at random among those who got admitted in labour room. Results: In the present series, incidence of breech deliveries came to be 4.1094%. Incidence of breech presentation was maximum (45%) in the age group of 21–25 years. In this study, out of 100 cases, 62 were multigravidae and 38 were primigravidae, and 43 cases (43%) were associated with factors which endanger of life of the foetus, among which twin pregnancy and pre-eclamptic toxaemia were the most commonly associated factors. In the present series, among 100 cases studied, 14 were breech babies and congenital malformation, of which hydrocephalus was the most common malformation found. Conclusion: The study concludes that prematurity is associated with high incidence of breech presentation. The most common variety of breech presentation is flexed breech, which is found more in multigravidae. Caesarean section is the mode of delivery of choice as it carries minimal foetal loss. Extended variety of breech is safest for the baby and carries minimal foetal loss.

Perinatal Outcome Following Singleton Vaginal Breech Delivery in the University of Calabar Teaching Hospital, Calabar: A 10-Year Review

All the patients who had vaginal breech delivery at the University of Calabar Teaching Hospital, Calabar over a 10 year period were reviewed. The aim was to determine the incidence of breech delivery and evaluate the perinatal outcome following vaginal breech delivery. Relavant information was obtained from the case notes of patients who had vaginal breech delivery. The incidence of singleton breech delivery during the study period was 1.41% and 69.34% of these had vaginal breech delivery. The perinatal mortality rate was 158/1000 births. Majority of vaginal breech deliveries occurred in multiparous women (56.8%) and at term (61.1%). The perinatal outcome was worse in babies who weighed above 3.5kg (50.0%), in those born to multiparous women (57.4%) and in those delivered by senior registrars (50.0%). There is need for the involvement of consultant obstetricians in the antenatal evaluation of all patients with breech presentation. Monitoring during labour and conduct of delivery must be by an obstetrician experienced in the art of vaginal breech delivery. Vaginal breech delivery should become part of every labour ward fire drill and appropriate training sessions should be organized for all obstetric residents. Key Words: Perinatal outcome, vaginal breech delivery, University of Calabar Teaching Hospital Mary Slessor Journal of Medicine Vol.4(1) 2004: 81-85

External cephalic version at term: a survey of consultant obstetric practice in the United Kingdom and Republic of Ireland.

To undertake a survey of external cephalic version (ECV) in the United Kingdom and Republic of Ireland. In June 1995 every consultant obstetrician and gynaecologist in the United Kingdom and Republic of Ireland was sent a postal questionnaire which asked whether ECV was routinely performed for breech presentation after 37 weeks of gestation, assuming no contraindications. If consultants did not perform ECV, a supplementary question inquired whether they referred patients to a colleague who would perform ECV. The questionnaires were colour coded for country and dispatched from the Postgraduate Education Department of the Royal College of Obstetricians and Gynaecologists (RCOG). Overall, 78% of questionnaires were returned. The percentage of consultants routinely practising ECV in each country was as follows: Northern Ireland 82%; Scotland 64%; Republic of Ireland 64%; England 43%; and Wales 41%. When these figures were compared with the latest RCOG Annual Statistical Returns for breech delivery and caesarean section for breech delivery, there was an inverse correlation between the percentage of obstetricians performing ECV in any one country and the incidence of breech delivery (P < 0.001). There was a similar inverse correlation for the percentage of obstetricians performing ECV and the caesarean section rate for breech delivery (P < 0.001). Although postal survey results are not necessarily an accurate reflection of what happens in clinical practice, these data are supported by evidence from the Cochrane Database of Systematic Reviews indicating that ECV after 37 weeks reduces the incidence of both breech delivery and caesarean section for breech delivery.

A comparative study on breech deliveries attended in 1992: hospital centers from Latin America versus Spain and Portugal

Objectives: The first aim of this study was to compare the incidence and management of breech deliveries, as well as perinatal mortality rates, in centers from Latin America versus Spain and Portugal in Europe. A second aim of this study was to analyse the correlation between the rates of c-sections and perinatal mortality. Methods: Data from 287 313 deliveries, 8,764 of which were singleton breech deliveries attended in 1992 in 30 centers from Latin America and 44 centers from Spain and Portugal, were provided by the doctors in charge of the obstetric services and analysed using a computer statistical package (R-sigma, Horus Hardware). Results: The incidence of breech deliveries was lower in centers from Latin America than in Spain and Portugal, 2.6% vs. 3.7%, respectively, but the percentage of preterm breech deliveries was higher in the former (23% vs. 17%; P < 0.001). In the total number of deliveries, c-sections were performed more frequently in Latin America, but the perinatal mortality rates were triple those in Spain and Portugal. In breech presentations from both geographical areas nearly 70% of c-sections were performed. However, the perinatal mortality rates in breech presentations were more than twice those of the total number of deliveries in Latin America, and more than three times in Spain and Portugal. There was no correlation between percentage of c-sections and perinatal mortality rates in the different centers in Spain and Portugal, but this correlation was significantly negative in both all and breech deliveries from centers in Latin America. Breech deliveries were more frequently monitored and attended by a specialist in Spain and Portugal. Conclusions: Preterm deliveries, c-sections and perinatal mortality were more frequent, and the correlation between these two latter rates was significantly negative for both all and breech deliveries in Latin America. As long as basic health care is still an issue in certain countries, it seems that a high rate of c-sections could prevent or reduce perinatal mortality. Yet, in countries with better health care standards, there is probably no need to perform c-section in most breech presentations.

Breech presentation in Spain, 1992: a collaborative study

Objectives: The goals of the present work were to study the incidence of breech deliveries in Spain, the causes for breech presentation and its management and the incidence of cesarean sections and its correlation with the perinatal mortality rates among different centers. Study design: Data from 102 038 deliveries, 3829 of which were singleton breech deliveries attended in 1992, were obtained from 40 hospital centers located in different autonomic communities of Spain and analyzed using a computer statistical package (R-sigma, Horus Hardware). Results: The incidence of breech deliveries was 3.8%, although this proportion varied between different centers and regions. Up to 18% of the cases occurred in preterm. The most frequent causes were prematurity and uterine malformations. In its management, an increase in the tendency to perform elective cesarean section was noticed. The incidence of cesarean sections reached 14.9% of the total and 67.9% in breech deliveries. Perinatal mortality rate in breech deliveries was more than four times that of all deliveries, according to national standards, and more than three times according to international standards (47.8 versus 11.8 × 1000, and 24.7 versus 8 × 1000, respectively). The intrapartum and neonatal mortality in breech deliveries was 13 × 1000. No correlation between incidence of cesarean sections and perinatal mortality rates was found. Primiparity, deflexed head, macrosomia and prematurity were the most decisive parameters to indicate a cesarean section. Neither the external cephalic version nor the total breech extraction were common procedures. Conclusions: The incidence of breech deliveries is variable between different centers (1.7%–5.1%) and Spanish regions (3.3%–4.3%), with a mean of 3.8% in overall and 11.4% in preterm deliveries. There is a tendency to perform cesarean sections, especially in primiparae. There is no correlation between the percentage of cesarean sections in each center and the perinatal mortality rate. External cephalic version and total breech extraction were uncommon procedures.

Congenital dislocation of the knee.

Twenty-three congenital knee dislocations in 17 patients were reviewed after an average follow-up of 11 years. There was a 30% incidence of breech delivery along with a 41% incidence of clubfoot. Treatment in serial casts was successful in 10 knees; 13 required operations. Prognosis was most favorable in unilateral cases and when surgery was performed before 2 years of age. Quadriceps lengthening during knee surgery facilitated the subsequent reduction of ipsilateral dislocated hip.

Some characteristics of breech deliveries.

AbstractTwo hundred and forty‐four patients with breech presentation occurring in a one year period of a total of 7676 deliveries were analysed. The incidence of breech deliveries was 3.2%. 57.4% of breeches occurred in primiparous patients and a quarter of them were delivered premature. 80% went into spontaneous labour whilst a third were delivered abdominally. 10.2% of the babies were less than 2270 g. The overall perinatal mortality rate of breeches over 1000 g was 55 per 1000. Some of the factors affecting the perinatal mortality were discussed.

57: Aetiology of Idiopathic Growth Hormone Deficiency in England and Wales

The relative importance of heredity, sex and the conditions of pregnancy in the aetiology of idiopathic GH deficiency was investigated in a case-control study of 140 patients. Certain items were investigated in a further 68 patients. In the main sample the ratio of boys to girls was approximately 4 to 1. Half of the affected children were first-born which is a significantly different proportion from the control population χ(1)2 = 6.77; p<0.01). The affected children had an incidence of breech delivery (11.47%) that was very significantly increased compared to controls χ(1)2 = 53.2, p<0.001). They also presented a significantly high incidence of forceps delivery (12%; χ(1)2 = 16.12, p<0.001). Breech and forceps delivery considered together occurred significantly more frequently in cases with multiple pituitary deficiency (43.1%) than in those with isolated GH deficiency (20%; χ(1)2 = 3.92, p<0.05). Early vaginal bleeding during pregnancy was significantly increased (7.5%; χ(1)2 = 7.05; p<0.01). The seasonal distribution and parental ages were normal. The true probability of a proband having another affected sib was 2.9 ± 1.5%. The relative risk of GH deficiency in males born by breech in primiparae is 10.5 times that of the general population; that of females, vertex in multiparae, 0.2 times. Routine screening of the population at risk is proposed.

Reduction of the hazards of breech presentation by external cephalic version

The hazards of breech presentation are sufficient to triple perinatal mortality when compared with cephalic presentation.Reduction in the incidence of breech deliveries can be obtained by the use of early external cephalic version, preferably done before the thirty-fourth week. The procedure requires careful observation, acquired skill, and gentleness and complications are negligible. As carried out in the present series, the incidence of breech delivery was reduced to 35 cases out of 2,978 single births, 1.2 per cent.