Bushra Rauf, Tayyaba Ayub.
Maternal and Perinatal outcome in term singleton breech presentation.
J Postgrad Med Inst Jan ;18(3):373-9.

Objectives: This study was carried out to determine the maternal and perinatal outcome in singleton term breech presentations in the pretext of mode of delivery so that appropriate management protocol can be devised without compromising fetomaternal well being. Material and Methods: This observational prospective study was carried out in obstetrics and gynaecology unit of Hayatabad Medical Complex Peshawar, from 1st January 2000 to 31st December 2000. All singleton term breech presentations were enrolled. Exclusion criteria included multiple pregnancies and preterm pregnancies. Data collected included age, present and past obstetric history, type of breech presentation, mode of delivery, indication for caesarean section either elective or emergency, fetal outcome and maternal complications. Results: During this study a total of 265 cases of singleton term breech presentation were delivered (4.7%). Vaginal breech delivery was carried out in 148 cases (55.8%)and caesarean sections in 117 cases (44%). Elective caesarean sections were done in 78 cases (29.4%), and majority of these were primigravida (68.75%). Emergency caesarean sections were done in 39 cases (14.7%). Of the emergency caesarean sections major indication was fetal distress in 14 cases (35.8%) and failure to progress and obstructed labour in 12 cases (30.7%). Route of delivery did not affect the perinatal outcome per say except for congenital abnormalities. Total number of congenital abnormalities associated with breech presentation were 7 and total number of intra uterine deaths associated with fetal and maternal problems were 13. All vaginal breech deliveries went into spontaneous labour and induction was performed in four cases, all were intra uterine deaths. Maternal and fetal complications were seen more frequently in the group requiring emergency caesarean section. Conclusion: Proper selection of cases for vaginal delivery, vigorous intrapartum monitering and proper technique of breech delivery have been established as the most important determinant for successful outcome in vaginal breech delivery without compromising fetomaternal well being and curtailing the caesarean section rate done for this mal presentation.

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