Caesarean versus Vaginal Delivery for Term Breech Presentation: A Comparative Analysis

Abstract

Delivery of fetuses at term in breech presentation has been a subject of debate in obstetrics. Reviewing the outcome following vaginal and caesarean deliveries will influence policies on the best route of delivery. To compare the neonatal and maternal outcomes between vaginal and caesarean births for fetuses presenting breech at term, a retrospective and comparative analysis of 78 singleton term breech deliveries in Nnamdi Azikiwe University Teaching Hospital, Nnewi over a 5- year period was done. Low 5-minute Apgar score, admission to neonatal intensive care unit, neonatal mortality and maternal morbidity were compared between vaginal deliveries and caesarean births. Assisted vaginal breech delivery was associated with significantly low Apgar score (score < 7) at 5-minutes (X²=8.19; OR =8.80, P=0.004), while mothers who were delivered through caesarean section had significantly, more morbidity (X²=3.14, OR=0.29, P= 0.04) compared to those who had vaginal delivery. There was no significant difference between the two groups in terms of neonatal intensive care unit(NICU) admission rate(X²=2.84, OR=2.56, P= 0.09) or neonatal mortality (X²=0.11, OR=1.60, P=0.38). Although assisted breech delivery was associated with more incidence of low Apgar score at 5-minutes, there was no significant difference in either the neonatal mortality rate or NICU admission rate. Assisted vaginal breech delivery in well selected patients is still relevant to our practice, despite the findings from the Term Breech trial.

Key Words; Breech Presentation, Term, Delivery