Factors associated with poor delivery outcomes among women delivering by breech in South Western Uganda: Unmatched case control study

Abstract

Background: It is globally observed that breech delivery through vaginal route is associated with more adverse neonatal outcomes compared to caesarian section including low 5 minute Apgar score and perinatal mortality increased. The ideal mode of delivery in breech presentation remains an area of intense controversy worldwide coupled with paucity of studies to high light factors associated with poor outcomes among breech deliveries.

Objective: This study set out to determine the neonatal delivery outcomes in women delivering by breech at Mbarara University teaching hospital, South Western Uganda and factors associated with poor neonatal outcomes among breech deliveries.

Methods: This was an unmatched case control study of 208 breech births between January to December 2014. Relevant socio-demographic and obstetrical variables were abstracted from patients’ records. The data was analyzed using SPSS and cross tabulations were done and frequencies, percentages and Pearson Chi-square statistics obtained. Bivariate and multivariate logistic regression models were used to test association. Significance level was set at p value < or = 0.05

Results: Among the 206 deliveries that were analyzed, 120 babies delivered by caesarean section (C/S) and 86 by assisted vaginal breech delivery. In the C/S group, 4 (3.3%) were fresh still births (FSB) and 116 (96.7%) were live births while in the assisted vaginal breech group, 25 (29.1%) were FSB and 61 (70.1%) were live births. Babies born by C/S had better Apgar scores at 5 minutes with 5 (4.1%) of babies born through C/S scored 0-6 while 115 (95.8%) scored between 7-10 whereas 31 (36%) of babies born by assisted vaginal breech delivery scored between 0-6 while 55 (64%) scored between 7-10. The factors associated with low Apgar scores at five minutes and fresh still births were vaginal mode of delivery, birth weight of less than 3 kilograms and multi-parity.

Conclusion: Safe caesarian section and birth weight >2.5kg is associated with better perinatal outcome among breech deliveries

Keywords: Breech delivery, mode of delivery, birth weight, Apgar score, perinatal outcome.