Should a Preterm Breech Go for Vaginal Delivery or Caesarean Section?

Abstract

ABSTRACT

Background: Breech presentation is a common type of presentation remote from term; those born with such presentation tend to have higher perinatal mortality and morbidity in comparison with cephalic presentation of the same gestational age. Evidence from term breech trial cannot be directly extrapolated to preterm breech delivery, which remains an area of clinical controversy. 

Objective: To determine the optimum mode of delivery of the preterm breech presentation depending on fetal and maternal outcomes.

Methods: A cohort study that had been conducted at AL-Elwiya Maternity Teaching Hospital in Baghdad through the year 2009. It involved 103 pregnant women between 24 completed weeks and before 37 completed weeks of gestation. The women were divided into three groups: first group (32 women) includes those who were delivered by a planned Caesarean section. Second group (34 women) includes those who were delivered by an emergency Caesarean section and third group (37 women) includes those who were delivered by vaginal route, and this division was according to obstetrical indications. Maternal morbid outcomes due to the effect of preterm breech delivery were determined and neonatal condition was determined by assessment of the Apgar score at 5 minutes, admission to neonatal intensive care unit (NICU) and neonatal death

Result: Birth weight and gestational age were found to be significantly effective in determining the mode of delivery and then the neonatal outcome. Very premature (< 32 weeks) neonates had increased risk of death by 29 times compared to premature (32-36 weeks) neonates. Planned Caesarean section significantly decreased the risk of neonatal death by four times compared to vaginal delivery, while emergency Caesarean section significantly decreased the risk of neonatal death by ten times compared to vaginal delivery, meanwhile no significant difference in the incidence of maternal complications was elicited between the three groups

Conclusions: Whatever the mode of delivery of preterm breech presentation was, the neonatal morbidity and mortality was only contributed to the effect of prematurity, and the decision for the mode of delivery in preterm breech presentation is to be decided on an individual basis.