MATERNAL & NEONATAL OUTCOMES AND ASSOCIATED FACTORS OF BREECH PRESENTATION AT AYDER COMPREHENSIVE SPECIALIZED HOSPITAL

Abstract

Background: Breech presentation, a longitudinal fetal lie where the buttocks or legs enter the pelvis before the head, is the most common malpresentation, occurring in 3-5% of singleton deliveries at term (37 weeks gestation or later) (1–3). While breech positioning is more frequent earlier in pregnancy due to the similar bulk of fetal poles, its persistence at term is less common and varies globally. Risk factors and prevalence underscore its clinical significance, yet the optimal mode of delivery—vaginal versus cesarean—remains contentious. Evidence suggests cesarean delivery reduces perinatal risks, but a WHO study highlights maternal mortality and severe morbidity rates 3.4 and 2.3 times higher, respectively, compared to vaginal delivery, fueling ongoing debate (4) (1,2,5–7). Objective: To assess maternal and neonatal outcomes of singleton term breech deliveries at Ayder Comprehensive Specialized Hospital from June, December 31, 2024 Methods: Hospital based cross sectional study conducted in Mekelle University at Ayder Comprehensive Specialized Hospital over 6 monthes period from June, December 31, 2024.IBM-SPSS version 27 was used. Descriptive analysis such as frequency, percentage, and mean, median was applied for different factors and outcomes. Logistic regression analysis was applied for statically significant variables with p value<0.05. Results: The prevalence of term breech presentation in this study was 3.2% (136). Majority, 102(75%) of them delivered via cesarean delivery (C/D), and 34 (25%) had vaginal breech delivery. Perinatal mortality rate was 123 per 1000 deliveries and 15 (11.0%) neonates admitted to the NICU. Of these, 5(33.3%) were diagnosed with perinatal asphyxia (PNA), and 5 (33.3%) had respiratory distress (RD) secondary to meconium aspiration syndrome (MAS), 5 (33.3%) had Early neonatal sepsis, 2(1.4%) had soft tissue trauma and hypothermia. Low APGAR scores (<7) were observed in 28 (20.5%) of neonates at 1 minute and 12 (8.8%) at 5 minutes. Maternal complications included postpartum hemorrhage (PPH) in 3 (2.2%) of cases, third-degree perineal tears 1 (0.7%), and wound infections 2 (1.5%).One mother experienced severe adhesions leading to organ injury (iatrogenic bladder injury) and required a hysterectomy. Conclusion: There was significant number of maternal and neonatal complication. Parity, early gestational age at delivery, birth of new born less than 2500gm and unintended pregnancy were associated with maternal and neonatal outcomes of singleton term breech deliveries. There was higher rate of CD (75%) for singleton term breech deliveries when compared to other similar tertiary level hospital. Easier access to effective contraception methods can certainly help to address un intended pregnancy. A protocol for the management of breech delivery and a regular training facility for junior residents to conduct assisted vaginal breech delivery is recommended. Achieving universal coverage of the recommended new WHO ANC contacts model is considered feasible through collaborative efforts among healthcare providers, facilities, and policymakers.