Breech delivery and foetal outcome: a review of 291 cases

In a three year period (September 1989 to August 1992), among 7,170 consecutive deliveries at Yekatit 12 Hospital, Addis Abeba, Ethiopia, there were 291 singleton breech deliveries with a 4% incidence rate at a gestational age of 28 weeks and above. In 28% and 57% of the infants, weight was below 2,500 grams and Apgar score was less than 7 in the first minute, respectively. The gross perinatal mortality rate for breech delivery in the first 24 hours was 330 per 1,000 deliveries, which was significantly higher than for the total number of deliveries (70 per 1,000; p < 0.001). However, the perinatal mortality rate was 1,000 per 1,000 deliveries for foetuses of less than 1,500 grams, 635 for foetuses between 1,500-2,500 grams, and 156 for foetuses of greater than 2,500 gm. In general, foetuses with low birth weight showed a high mortality rate (p < 0.001). There was also a two-fold increase in perinatal death in patients without antenatal care (p < 0.001). In order to reduce this unacceptably high perinatal mortality, emphasis must be given to appropriate training of physicians and midwives in the management of breech deliveries along with provisions of efficient prenatal care to improve birth weight. In addition, as most of the neonatal problems are preventable, measures need to be taken to establish neonatal units equipped with basic resuscitation materials and manpower.