Breech delivery pose a huge challenge to both the mother, foetus and midwife. This presentation provides analysis of 44,000 deliveries conducted in Muhimbili National Hospital between 2000-2002. The analysis showed that the outcome breech was poor regardless of parity of the mother.

1. REVIEW OF FETAL OUTCOME OF
ASSISTED BREECH DELIVERIES AT
MUHIMBILI NATIONAL HOSPITAL
2000-2
Dr. A.M. Makuwani
Dr. A.S. Nyamtema
MS. Suzan Ndambala
MS. Ipyana Miller
Jan 2003

2. INTRODUCTION
Until 2 decades ago all singleton breech
were delivered vaginally except for
added specific indications.
However, breech infants delivered
vaginally had 5-fold increase in mortality
rate compared to cephalic presentations
(Pernoll M et al, 1987)

3. Introduction cont…
Breech presentation at term occurs in 3-
4% deliveries
~50% of breech presentation are
candidates for vaginal delivery (Fischer
2002). Of these 60-82% successfully
deliver vaginally (Fischer 2002).
Therefore, breech delivery is a challenge
to the mother, foetus, midwife

4. Challenges facing breech
delivery
Cord compression…7.5%(Fischer et al
2002)
Cord prolapse - more in multipara than
primigravida. All these may lead to foetal
death or asphyxia.
Challenges …Birth trauma
# of humerus, clavicle or femur or
dislocation of shoulder or hip; caused
during extended arm or legs.
Erbs palsy, brachial plexus damage by
twisting the neck.

5. Challenges of breech……..
Trauma of internal organs esp. spleen
and liver while grasping the abdomen.
Adrenal trauma may lead into shock.
Spinal cord damage or # of the spine
caused by bending of the body backwards
Intracranial haemorrhage caused by rapid
delivery of the head or following hypoxia.

6. Method
Source of data: Muhimbili National
Hospital Obstetric Data Base
Simple ratios and STATCALC
program a package of EPI info6
were used for analysis.

7. Fetal mortalities among mothers admitted
with FHH-2000
Number Frequency
D-Home 11842 69.4%
Admitted 4193 24.6%
Died in LW 595 3.5%
Died in WD 36 412 2.4%
Unknown 27 0.6%
TOTAL 17069 100%
Summary: Perinatal deaths =5.9%

8. Fetal mortalities among mothers
admitted with FHH-2001
Number Frequency
D-Home 9570 66.0%
Admitted 4101 28.3%
Died in LW 365 2.5%
Died in WD 36 448 3.1%
Unknown 12 0.1%
Total 14496 100%
Summary: Perinatal deaths = 5.6%

9. Fetal mortalities among mothers admitted
with FHH-2002
Number Frequency
D-Home 8329 63.4%
Admitted 3884 29.8%
Died in LW 420 3.2%
Died in WD 36 337 2.6%
Unknown 50 0.4%
TOTAL 13018 100%
Summary: Perinatal deaths = 5.8%

10. Summary of Fetal mortalities among
mothers admitted with FHH-2000-2
Out of 44583 deliveries,
2577 (5.8%) had perinatal
death
There was a uniform trend
of perinatal death rates for
the past three years

11. Fetal mortalities following ABD
among babies admitted with FHH–
2000-2
Year Fetal deaths Total breech
No. (%)
2000 62 18.5% 335
2001 55 22% 250
2002 54 24.9% 216
Total 171 21.2% 801
NOTE: Breech in multiple pregnancy were excluded
from these analysis

12. Fetal morbidities among babies delivered by
ABD admitted with FH-beats -2002
Number %
Normal 119 82.1
Moderate asphyxia 22 15.2
Severe asphyxia 14 9.7
Total 145 100

13. Fetal outcome following ABD
according to parity in 2002
Primipara Para 1+ Total
No % no % No.
Died 23 (22.2) 19 (16.8) 42
Alive 80 (77.8) 94 (83.2) 174
Total 103 113 216
No significant difference of fetal outcome
following ABD between primigravida Vs
multips (P value=0.394)

14. Fetal outcome following ABD
according to fetal weight-2002
Fetal weight (kg)
1.0 -2.5 2.5 -3.5 3.6+ Total
no. % no. % no % no.
Died 23 (30) 14 (15) 3 (33) 43
Alive 54 (70) 80 (85) 6 (67) 140
Total 77 94 9 183
One third of 3.6+kg babies delivered
ABD had perinatal death.

15. Caesarian section rate among
breech presentations-2000-2
Year No. of CS %
2000 75 18
2001 93 27
2002 82 30
Summary:There is an increasing
trend of CS-rate due to breech
presentation.

16. DISCUSSION
These findings have demonstrated that
there is no statistically significant
difference of foetal outcome of ABD
between primes and multips
It is reported that Obstetricians believe
that primes have poorer outcome of
breech vaginal deliveries than multips.
However, data regarding vaginal delivery
in multiparous vs primes demonstrate no
benefit in perinatal outcome.(Pernoll et
al, 1987 and Fischer 2002)

17. Rate of Caesarian Section
CS rate among women with breech
presentation at MNH is low compared to
other studies.
Nahida (2000) reported a rate of CS of
54% following a prospective study.
Fischer (2002) reported that 65% of
women presented with breech are
candidates of CS.

18. Conclusion
Important findings:
High perinatal mortality and
morbidity associated with ABD.
The percentages of prenatal death
over three years have shown no
improvement. This calla for strategic
intervention.

19. SUBJECT FOR DISCUSSION
Why all these high perinatal death
rates following ABD at MNH?
?Skills in ABD techniques
?Low CS rates for breech presenting
babies
?Lack of external cephalic version
practice
?Beliefs among health care providers
about vaginal delivery performances of
breech presenting mothers. ?esp. multips

20. Suggestions
1. Mode of delivery of foetus
presenting with breech needs a
review.
Or
2. Opt for External cephalic
version.

21. END OF THE SHOW