Fetomaternal outcomes of singleton breech deliveries at Moi Teaching and Referral Hospital, Eldoret, Kenya

Abstract

Background: Breech presentation occurs in approximately 3% to 4% of all women at term with the incidence varying with the gestational age of the foetus. They are a major concern for both pregnant mothers and their reproductive healthcare providers because of the associated increased adverse maternal and perinatal outcomes. However, the evidence to support emergency caesarean sections rather than vaginal delivery for breech presentations is not clear cut. This necessitates a local study to describe fetal and maternal outcomes of singleton breech deliveries among women attending a major referral facility with breech presentations in Western Kenya region. Objective: The aim of this study was to describe the fetal and maternal outcomes of singleton breech deliveries at Moi Teaching and Referral Hospital (MTRH). Methods: This was a cross sectional descriptive study. The study participants were women with singleton breech deliveries at a gestation of 28weeks or more. Hospital records indicated that very few breech deliveries occurred at the facility per year. Therefore, a census of all the eligible women with singleton breech deliveries was taken. A semi-structured interviewer-administered questionnaire was used for data collection. Results: There were a total of 11, 957 deliveries at MTRH during the study period (30th August 2019 to 27th August 2020), of which 125 (1.045%) were singleton breech deliveries. Of these, 75 met the eligibility criteria to participate in the study whereby, 65 (86.7%) gave birth through emergency caesarean section while 10 (13.3%) had emergency vaginal breech delivery. Most women (50.67%; n=38) delivered at a gestational age of between 38 - 40 weeks and 72 (96%) of the women enrolled had live births. Most (66.70%) newborns weighed 2500 – 3499grammes with 70 (93.3%) newborns having a 5-minute APGAR score of≥7. Majority (85.3%) of the newborns did not have birth complications however, 5 (6.7%) were admitted to the newborn unit, 5(6.7%) had a clinical diagnosis of birth asphyxia while 1 (1.3%) had delayed aftercoming head. The maternal complications noted were second- and thirddegree perineal tears (5.3%), post-partum haemorrhage (4.0%) and anaesthetic complications (1.3%). Conclusions: This study noted that despite the MTRH breech delivery protocol recommendation for caesarean section for breech presentation, 13.3% of the women had vaginal breech deliveries. Birth complications (birth asphyxia, NBU admission and delayed aftercoming head) occurred in less than 15% of the newborns regardless of the mode of delivery. Furthermore, 40% of these women sustained second- and third-degree perineal tears. Recommendations: Because maternal complications were associated with the mode of delivery, efforts should be made to ensure that those with breech presentations are identified during antenatal visits, admitted at term and prepared for elective caesarean section. In addition, those with breech presentation in labour should be prepared for emergency caesarean section. From the study there was a higher rate of perineal tears among those who delivered vaginally in MTRH. Therefore, a training for health workers on vaginal breech deliveries would be recommended