Perinatal outcome of singltone breech delivery at mettu karl hospital oromia regional state, south west Ethiopia, crosscecsional retospective study

Abstract

Introduction: Breech deliveries have always been topical issues in obstetrics because of the very high perinatal mortality and morbidity. These are due to combination of trauma, birth asphyxia, prematurity and malformation. Neonates undergoing term breech deliveries have long-term morbidity up to the school age irrespective of mode of delivery. However, outcome of breech deliveries are not well understood in the Ethiopian setting. Objective: To assess the fetal outcome of breech deliveries at Mettu Karl Hospital. Methods: Hospital based cross sectional retrospective study was conducted on outcome of breech delivery utilizing a four years data at Mettu Karl Hospital, Oromoia Regional State South Western Ethiopia. Socio-demographic and pregnancy related information of all pregnant women who presented with a breech presentation and gave birth in the hospital was reviewed from Patient medical records at Mettu Karl hospital from March 1-30, 2013. The collected data was analyzed using SPSS for windows version 16.0. Descriptive statistics was run to describe the data by independent and dependent variables. The association between dependent and independent variables was determined by Odds Ratio. A P value of less than 0.05 was considered statistically significant in all tests of association. Result: During the 4 years study period, a total of 164 singleton term breech deliveries were recorded out of 5628 deliveries giving the prevalence of singleton term breech deliveries in the hospital during the study period to be 3%. It was recorded in this study that, the perinatal outcome of breech deliveries were 139(84.8%) born alive and 25(15.2%) were dead indicating that the perinatal mortality rate to be 152 per 1000 breech presentations. Among live born, neonatal condition within the first 5 minute showed that, 115 (70.1%) born healthy, 23(14%) asphyxiated and 1(0.6%) born with birth injury. The possible causes of death for dead delivered fetus were entrapment of head 10 (40%), birth asphyxia 8 (32%), cord prolapse 4(28%) and intrauterine death with unknown cause 3 (12%). Mode of delivery was found to be significant on multivariate analysis. Vaginal delivery have significant statistical association with perinatal outcome of breech delivery (p=0.006). Vaginal delivery have (29) times risk to have perinatal loss than Caesarean delivery (AOR=29.68, 95% CI 2.68- 33.06)II Conclusion and recommendation: In this study, it can be concluded that the perinatal mortality rate, of 152 per 1000 breech deliveries, was high indicating that breech delivery to be associated with an increased perinatal mortality and morbidity than caesarean delivery. Entrapment of head, birth asphyxia and cord prolapse were the most common causes of perinatal mortality. In general, perinatal outcome was significantly associated with vaginal delivery, failure to attend ANC, early rupture of membrane and fetal weight factors in this study. Obstetricians, midwives, and other health care personnel conducting deliveries should receive a continuous medical education to update on how to conduct vaginal breech deliveries.