Changing trends in the management of singleton breech presentation at term a retrospective study of 954 cases over a 3-year period

Abstract

OBJECTIVE: The aim of this study was to analyse term breech deliveries, with regard to the influence of the mode of delivery on the frequency of perinatal mortality and morbidity and.to assess changes in the management of singleton term breech presentation. STUDY DESIGN: A retrospective study including 954 term singleton (>or =37 weeks gestation) pregnancies with breech presentation delivered at a referral hospital, SSK Göztepe Educational Hospital, between January 01, 2000, and December 31, 2002. The patients' records were identified from the delivery database by each year period. To compare the effect of the mode of delivery on short-term perinatal outcome, patients were divided in two groups by parity. There were 560 primiparas and 394 multiparas in this 3-year period. The primary outcomes were perinatal mortality, neonatal morbidity and referrals to the neonatal intensive care unit as a whole stratified by parity and mode of delivery. Test of proportion was performed in statistical managament of datas and the differences were evaluated by chi-square test . RESULTS: Out of 35 560 deliveries in our hospital in the study period, there were 1157 singleton breech presentation (3.25%). Preterm and intrauterine dead babies were excluded. All singleton breech presentation pregnancy at term (37-42 weeks), with a live fetus, were 954. Cesarean section was performed in 527 (94.11%) primiparas and in 257 (65.22%) multiparas. There was a significant linear increase in the cesarean birth rate of primiparas over a 3-year period, for each year it was 88.88%, 96.82% and 97.11%, accompanied by a modest linear increase for multiparas, 58.19%, 69.17% and 67.62%, respectively. This was associated with a significant decline in neonatal mortality and referrals to the neonatal intensive care unit in the first year of study (p=0.038), but there were no statistically significant differences in the second (p=0.272) and third year of study (p=.0.505). CONCLUSION: Cesarean section has gradually become the preferred mode of delivery for term breech presentation, especially in primiparas. This change in trend may be influenced by maternal wishes and avoid for facing to media and law problems due to traumatic vaginal delivery . A trial of vaginal delivery should be allowed in suitably selected cases before obstetricians loose the skills and confidence performing an assisted vaginal breech delivery.