Original Research Article

MODE OF DELIVERY AND NEONATAL OUTCOME IN BREECH PRESENTATION

Dr. Afsha Khan, Dr. Reena Pant, Dr. K.P. Banerjee
Department of Obstetrics and Gynaecology, SMS Medical College, Jaipur (Rajasthan)
Article Info: Received 19 January 2021; Accepted 27 February
DOI: https://doi.org/10.32553/ijmbs.v5i3.1796
2021 Corresponding author: Dr. Reena Pant
Conflict of interest: No conflict of interest.
Abstract
Background: Breech presentation is the commonest malpresentation with incidence of 3-4% at term. This study was done
with the objective of studying the mode of delivery in breech presentation and to compare the neonatal outcome in women
delivered vaginally to those delivered by cesarean section.
Methods: This prospective observational study was conducted in obstetric and gynaecology department of SMS Medical
College, Jaipur (Rajasthan). In this study group 100 women with breech presentation were included who were studied
with respect to their gestational age, birth weight, type of breech, mode of delivery and neonatal outcome.
Results: 100 women with breech presentation, 60% women delivered by cesarean section and 40% women delivered by
vaginal delivery. APGAR score was less than 5 at 1 min. in 17.50% of vaginally delivered newborns and 6.66% in cesarean
section delivered newborns(p value = 0.171). Admission to NICU were 25% in normal vaginal delivered newborns and 13.33%
in cesarean section delivered newborns (p value =0.05). There was no perinatal mortality noted in both groups. Conclusion:
Although APGAR at 1 & 5 minute were low in newborns delivered by vaginal delivery as compared to cesarean section but the
difference was not much significant. So vaginal delivery is still a safe option for breech babies with proper selection and when
conducted by a skilled obstetrician.
pregnant women were enrolled , inclusion criteria were
Introduction
singleton pregnant women with breech presentation at term,
Breech presentation is a longitudinal foetal lie in which the who gave written consent and were willing to participate in
foetalpodalic pole consisting of the buttocks, feet or the study. Those with intrauterine fetal death were excluded. A
knees is the leading pole at the pelvic brim. Incidence of thorough relevant history, general physical and obstetrical
breech presentation decreases with increasing gestational examination was performed along with routine antenatal
age. Incidence is about 20% at 28 week and drops to 5% at blood, serum, urine investigations was performed, if not
34 week and to 3% to 4% at term. Breech presentation has done earlier. Ultrasound examination was done to know type
been associated with many complications during pregnancy of breech, attitude of fetal head, nuchal arms, and estimated
and labour as breech. Breech is a most common fetal weight. Vaginal delivery was allowed in cases where
malpresentation. The maternal complications and fetal there was reassuring CTG at admission, estimated foetal
morbidity and mortality are higher in case of breech weight was not more than 3.5 kg, with no foetopelvic
presentation. Different modes of delivery for breech disproportion or placenta praevia and presentation as frank
presentation can be spontaneous breech delivery, assisted or complete breech.
breech delivery, caesarean section. It is essential to maintain
Patient selected for vaginally delivery was carefully
the skills of vaginal breech delivery especially in our
monitored and assisted breech delivery was conducted with
country with limited access to operative delivery & in
pediatrician in attendance. Caesarean section was carried out
situation such as precipitous labour, second stage labour,
as an elective or emergency basis of placentaprevia, fetal
anamoulous foetus, mother’s preference for vaginal birth
distress, previous caesarean section, footling breech,
etc. The vast majority of the morbidity and mortality
oligohydraminos, foetopelvicdisproportion, cord prolapse,
associated with breech delivery is attributed to three factors:
failure to progress and of maternal request. Evaluating the
- Cord compression, occurrence of nuchal arms, difficulty in
newborns at birth was done for gestational age, APGAR
birth of the after coming head. Caesarean section for breech
score at 1 min. & 5 min., congenital malformations and birth
also requires skill and expertise, as problems of birth injury,
injuries .Mother &newborns was followed till discharge
traction on fetal spine & difficulties of after coming head
from hospital and neonatal mortality and morbidity &
etc.
maternal morbidity was noted.
Material and Methods
Results
It was a prospective, observational, longitudinal study
conducted in the department of Obstetrics and Gynaecology,
SMS Medical college, Jaipur. In this study total 100
Table 1: Distribution of Cases According to Mode of section delivery, 4 newborns (6.66%) had APGAR
Delivery score at 1 min as <5/10 and 56 newborns (93.33%)
Mode of Delivery No. % had more than 7/10. p-value of APGAR score at 1 min
Normal Vaginal 40 40.00 is 0.171 which is statistically insignificant.
Delivery Cesarean 60 60.00 Among 40 cases of normal vaginal delivery, 6 newborns
Section 10 100.00
(15.00%) had APGAR score at 5 min <5/10 and 34
Total 0
Among 100 cases, 40 (40.00%) cases of breech newborns (85.00%) had >7/10. Among 60 cases of
presentation delivered by vaginal delivery and only 60 cesarean section, 4 newborns (6.66%) had APGAR
(60.00%) delivered by cesarean section. score <5/10 and 56 newborns (93.33%) had >7/10. p-
Table 2: Association of Mode of Delivery With Birth value is 0.307 which is statistically insignificant.
Although in my study APGAR score at 1 min and 5 min
Weight of Newborn is lower in vaginally delivered newborns than
Birth Weight of Newborn (in gms) Normal Cesarean
Delivery Section cesarean section but this difference is not much
No. % No. % significant. It shows that neonatal outcome was not
2000 - 2400 7 17.50 2 3.33 influenced by mode of delivery.
(n=9) 2500 - 31 77.50 40 66.67
2900 (n=71) 2 5.00 12 20.00 Table 4: Association of Mode of Delivery With
3000 - 3400 0 0.00 6 10.00 Admission in NICU Normal Delivery Cesarean Section
(n=14) >3500 40 100.00 60 100.00 Admission
(n=6)
p = 0.004 No. % No. %
Total in NICU
Presen 10 25.00 8 13.33
Among 100 newborns delivered, 9 newborns had birth
weight between 2-2.4 kg, out of which 7 newborns (17.50%) t 30 75.00 52 86.67
were delivered by vaginal delivery and 2 newborns (3.33%)Absent 40 100.00 60 100.00
delivered by cesarean section. Total
p = 0.05
71 newborns had birth weight between 2.5-2.9 kg, out of Maximum newborns 10 (25.00%) admitted to NICU
which 31 newborns (77.50%) were delivered by vaginal were from normal vaginal delivery and 8 (13.33%)
delivery and 40 newborns (66.67%) delivered by cesarean newborns admitted in NICU delivered by cesarean
section. 14 newborns (14.00%) had birth weight between section
3- but the difference was not much significant.
3.4 kg, out of which 2 newborns (5.00%) were delivered byp-value is 0.05. It shows that mode of delivery was
vaginal delivery and 12 newborns (20.00%) delivered by not a significant factor which influenced admission to
cesarean section. 6 newborns (6.00%) had birth weight >3.5NICU. Birth asphyxia and birth trauma were most
common causes of neonatal morbidity and admission
kg. All 6 newborns were delivered by cesarean section, none
of them was vaginally delivered. to NICU.
Most of the cases had birth weight between 2-2.9 kg in both Table 5: Association of Neonatal Outcome to Mode of
the vaginally delivered and in cesarean section delivered Neonatal
DeliveryOutcome
(n=100) Normal Cesarea Total
patients. Most of the cases of cesarean section had newborns Delivery n
weight more than 3 kg. p-value is 0.004 which is statistically Shift to Mother Side 30 Section 82
significant. It shows that birth weight is a significant factorAdmission of NICU 52
10 18
deciding mode of delivery but not influence neonatal 1. Respiratory Distress Syndrome 2
8
5
outcome. 3
2. Birth Asphyxia 3 6
Table 3: Distribution of Cases According to APGAR Score 3. Birth Trauma 3
3
3
after 1 and 5 Minute and Mode of Delivery 0
4. Hypoglycemia 1 3
APGAR Count of APGAR at 1 Minute Count of APGAR at 5 2
5. IntraventricularHaemorrhage 1 1
Score Minute 0
ND CS 6. Still Birth 0 0
ND CS
0
5/10 7 (17.50%) 4 (6.66%) 6 (15.00%) 4 (6.66%) Among 40 cases of normal vaginal delivery 10
Total 11 10 newborns shifted to NICU. Out of which, 2 newborns
7/10 33 (82.50%) 56 (93.33%) 34 (85.00%) 56 had respiratory distress syndrome, 3 newborns had
(93.33%) birth asphyxia, 3 newborns had birth trauma, 1 newborn
Total 89 90 had hypoglycemia due to presence of gestational
p-value 0.171 0.307 diabetes mellitus in mother and 1 newborn had
intraventricularhaemorrhage.
Among 40 cases of normal vaginal delivery, 7 newborns
(17.50%) had APGAR score at 1 min as <5/10 and 33 Among 60 cases of cesarean section, 8 newborns
newborns (82.50%) had >7/10. Among 60 cases of
cesarean shifted to
NICU. Out of which, 3 newborns had respiratory
distress 31 | Page
syndrome, 3 newborns had birthasphyxia and 2
newborns
had hypoglycemia due to presence of gestational factor which influenced admission to NICU. Birth
diabetes mellitus. There was no still birth and perinatal asphyxia and birth trauma were most common causes
mortality noted. of neonatal morbidity and admission to NICU.
Most common cause of neonatal morbidity in vaginally Similar to our study, Igwegbe AO et al (2010) reported
delivery
cesareanis birth trauma and birth asphyxia and in
that
section, birth asphyxia and respiratory distress
32.00% of vaginally delivered newborns and 10.00% of
syndrome. Discussion cesarean delivered newborns got admitted to NICU
This study showed that birth weight is a significant but p-
factor value
showedis 0.09 which is not statistically significant. It
deciding mode of delivery. Most of the cases had birth that neonatal outcome was not affected by mode of
weight between 2-2.9 kg in both the vaginally delivered
delivery.
and Study
that conducted by Mukhtar B et al (2013) reported
in cesarean section delivered patients. Most of the
cases of admission to NICU was more in vaginally delivered
cesarean section had newborns weight more than 3
group
kg. p- (8.30%)
(5.00%).as
p-compared to cesarean section group
value is 0.004 which is statistically significant. A study value is 0.4 which is not statistically significant which
conducted by Lukas J et al (2018) compared
was
maternal and comparable to our results. Similar to our results other
neonatal outcome of intended vaginal breech studies like Giuliani A et al (2002), Lukas J et al
deliveries of
newborns having birth weight of 2.5-3.7 kg and to (2018),
those of Alarab A et al (2004) and reported no significant
difference
newborns having birth weight of 3.8 kg and more. in neonatal morbidity in vaginally delivered and
Although
according to this study maximum newborns i.e. 45.00% cesarean
having birth weight >3.8 kg were delivered by cesarean section delivered newborns in term breech.Study
section but in our study all newborns having birth conducted
by Eide MG et al (2005) also reported no significant
weight
difference in intellectual performance in vaginally
>3.5 kg were delivered by cesarean section, so these delivered
studies 57
were comparable. and cesarean section delivered newborns. Similarly
study
In this study, neonatal outcome was not influenced by conducted by Goffinet F et al (2006) reported that 2.1%
newborns
1.
and
Karningin vaginally
RK, Bhanu BT,delivered gotofadmitted
Sarojini. Mode tooutcome
delivery and NICU
mode of breech presentation: a prospective observational study in a
of delivery. Although in this study APGAR score at 1 1.5%tertiary
newbornscentre.of
Intcesarean section delivery
J Reprod Contracept got 2017
Obstet Gynecol.
min Aug;6(8):3409-3413.
and 5 min is lower in vaginally delivered newborns than admitted
2. to L, Kielland-Kaisen U, Paul B, Mollmann CJ, Klemt
Jennewein
cesarean section but p value at APGARat 1 min. is NICU.AS,Though
Schulzethis
S, study
Bock N, showed that difference
Schaarschmidt was not
W, Bruggmann D,
0.171 Louwenwhich
significant F. Maternal and neonatal
was similar outcome after vaginal
to our study.
and p value of APGAR at 5 min. is 0.307 which is not breech delivery at term of children weighing more or less than
statistically
outcome was significant. It shows that neonatal Conclusion
3.8 kg: A FRABAT prospective cohort study. PLoS One. 2018
Aug 23;13(8):e0202760. doi:
not influenced by mode of delivery. Although APGAR at 1 & 5 minute
10.1371/journal.pone.0202760. were low
eCollection in
2018.
3. Mukhtar B, Khan B, Rasheed N. Breech presentation at term;
An experimental study conducted by Mukhtar B et al newborns
fetal outcome in planned cesarean section versus planned
vaginal
delivered bybirth. Professional
vaginal delivery Med
asJ.compared
2013;20(4):526-529.
to cesarean
(2013) Giuliani A, Scholl WMJ, Basver A, Tamussino KF. Mode of
4.
section but the difference was not much significant. So
reported that mean APGAR score at 1 min and 5 min in delivery and outcome of 699 term singleton breech deliveries
vaginally delivered newborns was 8.47 and 9.53 vaginal
at delivery
a singlestillcenter.
a safe option
Am J for breech
Obstet babies with
Gynecol. 2002
respectively and also in cesarean section delivered proper selection and when
Dec;187(6):1694-8. conducted by a skilled
doi: 10.1067/mob.2002.127902.
newborns Alarab M, Carmen Regan, O'Connell MP, Keane DP, O'Herlihy
obstetrician.
5.
mean APGAR score at 1 min and 5 min was 8.58 and C, Foley ME. Singleton vaginal breech delivery at term: still a
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