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