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Background: A breech birth is the birth of a baby from a breech presentation. In breech
presentation, the baby enters the birth canal with the buttocks or feet first, as opposed to the
normal head first cephalic presentation. About 3–4 % of all pregnancies have breech
presentation at term. First-time breech presentation at term occurred in 4.2% of first pregnancy
deliveries, 2.2% of second pregnancies and 1.9% of third pregnancies. The rate of breech
recurrence in a second consecutive pregnancy was 9.9%, and in a third consecutive pregnancy
after two prior breech deliveries was 27.5%.Delivery of breech presentation was associated
with increased risk for both mother and fetus as compared to cephalic presentation. Despite of
this evidence there was scant information in breech presentation and its associated adverse
maternal and perinatal outcomes. Understanding the burden of breech presentation and
associated factors is important to help designing strategy to reduce those adverse perinatal and
maternal outcomes related to breech presentation. This study aims to determine the mode of
delivered associated perinatal and maternal outcomes for breech delivery at Kilimanjaro
Christian Medical Center (KCMC).
Objective: To evaluate mode of delivery and birth outcome of breech presentation in
multiparous women and assess overall risk for cesarean mode of delivery at KCMC hospital
Methodology: This was a retrospective cohort study was conducted using KCMC medical
data. The study was conducted at KCMC Obstetrics and Gynecology department. KCMC is
one of the four hospitals in Tanzania and was involves all multiporous women delivered at
KCMC Referral Hospital at maternity ward between 2010 to 2015. We excluded nullporous
and multiple gestation to minimize over representation of high risk women and missing data
were excluded. Descriptive statistics were summarized using frequency and proportions;
student t test was used to compare differences in mean between groups, Chi square test
statistics was used to compare difference of proportions between categorical variables. Both
crude and adjusted odds ratio (ORs) with 95% CI for risk factors and maternal and perinatal
outcome associated with multiporous breech presentation was computed using multiple logistic
regression models. P value of less than 5% (2 tails) was considered statistical significant and
data were analysed by SPSS program.
Results: Women with age less than 30 years were significantly associated with caesarean
section as mode of delivery, age less than 30 years were 2 times higher odds of delivery
through caesarean section compared to women with age more than 30 years OR 2.34 (1.21-
4.72), Married were 2 times higher odds of delivered through caesarean section compared to
unmarried women OR 2.44 (0.45-0.9), Women with higher level of education were 2 times
x
higher odds of delivery through caesarean section compared to women with primary education.
Women with cord prolapsed were 2 times higher odds of delivery through caesarean section
compared to women with no cord prolapsed OR 2.1 (1.2-5.6), attended antenatal visits more
than 4 were 2 times higher odds of delivery through caesarean section compared to women
with less than 4 antenatal visits OR 2.14 (1.11-4.17).Pre-eclampsia women and women with
gestation age less than 37 weeks were 2 times higher odds of delivery through caesarean
compared to women with gestation age more than 37 weeks OR 1.5 (1.67-2.51). Children with
Apgar score at 1 minute more than 7 were 6 times higher odds of being delivered through
caesarean section compared to children with apgar score less than 7. Also children with apgar
score more than 7 at 5 minute were 5 times higher odds of delivered through caesarean section
compared with children less than 7 apgar score at 5 minute and children with birth weigh more
than 2.5 Kg were 3 times higher odds of delivered through caesarean section compared to
children less than 2.5 Kg. Neonatal death, congenital abnormality, intra-uterine fetal death
outcomes were assessed but found not to be significantly associated with caesarean section
delivered. Maternal death, premature rupture of membrane outcomes were significantly
associated with mode of delivered, multiparous women women with no death during delivered
were 2 times higher odds delivered through caesarean section compared to women with death
during delivery. Admission to ICU, pre eclampsia, Ante partum hemorrhage, eclampsia, blood
loss more than 500 ml and placenta abruption also were assessed but found not to be
significant associated with mode of delivery (caesarean section).
Conclusion: In study cesarian section is seem to be preferred mode of delivered in breech
presentation since it reduce both maternal and fetal birth outcome. Furthermore vaginal breech
delivery was associated with higher fetal death, low apgar score both at 1 and 5 minutes and
low birth weight compared with caesarian section delivery. Early identification breech
presentation and provision of appropriate management during labour and delivery may reduce
the poor maternal and perinatal outcomes among women with breech presentation. Although
vaginal breech delivery was shown to have more adverse fetal outcomes compared to caesarian
section should not be discouraged as it have some benefit for the mother in terms of blood loss
and wound infection. |
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