Feto-maternal outcomes of term assisted breech deliveries at the University Teaching Hospital, Lusaka, Zambia

Abstract

Background: Breech presentation occurs when the fetus presents with buttocks or feet first. Globally, the incidence of breech is 3-4% at term. The safest mode of delivery for most breeches at term is still controversial despite extensive research. The aim of this study was to determine the feto-maternal outcomes of assisted term breech deliveries at the University Teaching Hospital (UTH).

Methods: A cross sectional study was conducted in 73 pregnant women with term breech admitted to the labor ward that delivered vaginally. Data was collected by administering a structured questionnaire and from medical records. The Pearson's chi-squared test was used for comparison of proportions between groups. One multivariate logistic regression was used to determine associations with neonatal intensive care unit (NICU) admission and also a second one associations with type of breech.

Results: The mean age of the participants was 30.6 ± 5.5 (range 18-41) years. The mean gestational age at delivery was 38.6 weeks and mean parity was 3.4, with a 5% history of previous breech. The average levels of asphyxia measured by Apgar score were 7.1 at 1 minute, 8.1 at 5 minutes and 8.6 at 10 minutes. The average fetal weight was 3200g, with 10% admissions to Neonatal intensive care unit (NICU). For the maternal outcomes, one participant had postpartum haemorrhage (PPH), and one participant had an episiotomy and none had symphysiotomy. On multivariate analysis, NICU admission was associated with lower Apgar score at 1 minute. Babies that were not admitted to NICU had 90% reduced odds for low Apgar score < 7 [Adjusted Odds Ratio (OR) = 0.10, 95% Confidence Interval (CI) = 0.004 – 0.24, P value < 0.01. Also, on multivariate analysis, type of breech was associated with lower Agpar score at 5 minutes. Compared to footling breech, patients with extended breech had 97% reduced odds for low Apgar score < 7 (OR 0.03, 95% CI 0.004 – 0.22, p-value < 0.01). Patients with complete breech had 85% reduced odds for lower Apgar score < 7 (OR 0.15, 95% CI 0.05 – 0.44, pvalue < 0.01).

Discussion and Conclusion: Feto-maternal outcomes of assisted term vaginal breech deliveries at UTH were favourable with low levels of asphyxia, neonatal admissions to NICU, and need for blood transfusion. Therefore, breech vaginal delivery at term may still be a viable option at UTH as demonstrated by this study.

Keywords: Term, Breech presentation, breech delivery, Apgar score