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Breech deliveries in a secondary health-care facility in South-South Nigeria

Context: The optimal mode of delivery for breech presentation remains an issue of debate among obstetricians. The care during labor, delivery methods used, and the skills of the birth attendant influence outcome of fetuses in breech presentation. Objectives: The objective of this study is to determine the incidence, mode of delivery, and outcome of singleton breech deliveries in a secondary health facility in South-South Nigeria. Materials and Methods: The case notes of all patients who had singleton breech delivery from January 1, 2009, to December 31, 2014, were studied. Data extracted were age, parity, booking status, mode of delivery, indication for cesarean section (CS), birth weight, Apgar score at 5 min and fetal outcome. The data were analyzed using SPSS Version 20 statistical package.P < 0.05 was considered statistically significant. Results: There were 172 singleton breech deliveries and a total of 5736 deliveries during the study, giving an incidence of 3%. The mean age of the patients was 27 ± 5.4 years. About 36% of the patients were nulliparous, and over half (54.7%) of the patients were booked. About 55.2% of the patients had CS, most (67.4%) of whom were booked. The most common (26%) indication for CS was for breech presentation in primigravida. There were 122 live births (70.9%) and 50 stillbirths of which 36 (20.9%) were fresh stillbirths. The stillbirth rate was 290.7/1000 compared with 54/1000 births for singleton cephalic presentation for the same period. The mean birthweight was 2.96 ± 0.76 kg. Fetuses that weighed ≥3.5 kg had significantly poorer outcomes (P < 0.0001). The babies delivered by CS had better Apgar scores at 5 min compared to those that had vaginal breech delivery. Conclusion: CS offers a better fetal outcome for singleton breech presentation and fetuses weighing ≥3.5 kg have a poorer outcome at delivery in our facility.