Abstract

Background: Breech presentation is the commonest form of mal-presentation. It occurs when the fetus occupies a longitudinal lie with the pelvic extremity at the brim and head at the fundus of the uterus. But the mode of delivery still remains controversial; the type of breech is sometimes taken into account. Breech presentation is linked to poor incidence of maternal and perinatal morbidity.

Aim: The objective of this study is to identify the associated factors and outcomes of breech delivery among pregnant women at the Limbe Regional Hospital.

Method: This study was a hospital based retrospective study. A convenient sampling technique was used to select appropriate files. A data extraction sheet was the main tool used for the data collection. Files from the 1st March 2018 to 30th February 2023 were studied at the Limbe Regional Hospital.

Results: The incidence of breech delivery was 1.4% with frank breech being the commonest type and it was associated with: Oligohydramnios, gestational diabetes, a history of cesarean section, preeclampsia. The risk of breech presentation was higher in primiparas compared to women with previous deliveries, with cesarean section being the common mode of delivery. The main maternal outcomes were premature rupture of membrane, prolonged labor and postpartum hemorrhage with fetal outcomes being birth asphyxia and admission in the neonatal intensive care unit.

Conclusion: The incidence of breech deliveries is low and is mostly associated with oligohydramnios, primiparity with the outcomes being prolonged labor and birth asphyxia.

CHAPTER ONE

INTRODUCTION

1.1 BACKGROUND

Breech presentation is defined as a fetus in a longitudinal lie with the head at the fundus of the uterus and buttocks or feet closest to the cervix [1]. The percentage of breech deliveries decreases with advancing gestational age from 22-25% of births prior to 28 weeks gestation to 7-15% of births at 32 weeks gestation to 3-4% of births at term (37-42 weeks) [2].

There are three types of breech presentation; complete, incomplete and frank, with frank breech presentation being the commonest type of breech presentation [3]. In the frank breech presentation (48 to 73%), both hips are flexed and both knees are extended. In the complete breech position (4.6 to 11.5%), both hips and both knees are flexed. In the incomplete breech position (12.4 to 40.5%), one or both hips are not completely flexed [4].

Breech presentation is the commonest mal-presentation with the incidence of 3-4% of all fetal presentation at term [4]. Globally, there is a variation in the incidence of term breech presentation. Its incidence is reported to be 3.7% in United States of America, 8% in India and 5.3% in South West Ethiopia [5, 6].

A study done in Nepal reported a prevalence of 5.03% for the incidence of breech delivery [7]. Also another study in Southern Ethiopia and Nigeria reported the incidence of term breech delivery to be 3.8% and 2.1% respectively [8,9]. In Cameroon a study was done at the Yaoundé General Hospital, where the incidence of breech delivery at term was found to be 2.98% [10].

In term pregnancies, breech presentation was associated with advanced maternal age, nulliparity, maternal hypothyroidism, pre-gestational diabetes, placenta praevia, olygohydriamnnios, congenital abnormally, female sex[1,11].

Many women present in labor with an undiagnosed breech presentation, with increased risks of fetal morbidity and mortality [12].  The clinical diagnosis of breech presentation is made by abdominal examination [13], using the Leopold maneuvers in combination with cervical examination and ultrasound is done to conclude the diagnosis [14]. Leopold maneuver is used to determine the position, presentation and engagement of the fetus in utero, while ultrasound examination is the current investigation for ensuring fetal presentation [15].

Morbidity and mortality related to pregnancy and child birth are serious problems worldwide especially in less developed world [16]. Breech delivery is a high risk pregnancy with adverse fetal outcome during pregnancy and labor [17]. A case study done at Adlucem Hospital Douala in Cameroon reported an infant born in breech presentation through cesarean section with fracture of the femur [18].

A study reported cesarean section, instrumental vaginal delivery, postpartum hemorrhage, death to be some of the major maternal outcomes of breech delivery with birth trauma, neonatal intensive care admission, brachial plexus injury, perinatal death, birth asphyxia, low apgar score to be the to be the major fetal outcomes[19].

Another study done in Cameroon showed that women that had vagina breech delivery were more likely to have prolonged labor and their newborn suffered from birth asphyxia [20]. A similar study showed that perinatal mortality and morbidity in the planned vaginal breech delivery were significantly higher than with planned cesarean delivery [21].

1.2 Statement Of Problem

Breech deliveries are common with mode of delivery difficult to adopt [4] and Breech delivery is a high risk pregnancy with adverse fetal outcome during pregnancy and labor [17].  It is associated with maternal and fetal complications therefore experienced and well trained staff with specific skills is required [20]

1.3 Justification

The study was done in order to come out with the incidence of breech delivery in the Limbe Regional Hospital. Despite several studies done, this study will help us assess the outcome of breech delivery at the Limbe Regional Hospital and may enable the Hospital to establish a better protocol for the management of breech presentation.

1.4 Research Question

1. What is the prevalence of breech delivery among women at the Limbe Regional Hospital?
2. What are the factors associated with breech delivery among women at the Limbe Regional Hospital?
3. What are the maternal and fetal outcomes of breech delivery at Limbe Regional Hospital?

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