SlideShare a Scribd company logo
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
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)
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
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.
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.
Method
Source of data: Muhimbili National
Hospital Obstetric Data Base
Simple ratios and STATCALC
program a package of EPI info6
were used for analysis.
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%
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%
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%
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
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
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
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)
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.
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.
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)
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.
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.
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
Suggestions
1. Mode of delivery of foetus
presenting with breech needs a
review.
Or
2. Opt for External cephalic
version.
END OF THE SHOW

More Related Content

What's hot

Cord Prolapse
Cord ProlapseCord Prolapse
Cord Prolapse
limgengyan
 
Cord prolapse sasi (2)
Cord prolapse sasi (2)Cord prolapse sasi (2)
Cord prolapse sasi (2)
sasikalaarun2
 
Breech presentation
Breech presentationBreech presentation
Breech presentation
Ali S. Mayali
 
Breech presentation
 Breech presentation Breech presentation
Breech presentation
rppathi1957
 
Midirs Cord Prolapse
Midirs Cord ProlapseMidirs Cord Prolapse
Midirs Cord Prolapse
Unidad Docente Matronas Ceuta
 
Shoulder dystocia
Shoulder dystociaShoulder dystocia
Shoulder dystocia
Dr Zharifhussein
 
Breech presentation
Breech presentationBreech presentation
Breech presentation
Meklelle university
 
Unstable lie
Unstable lieUnstable lie
Unstable lie
Upwork
 
Cord Prolapse
Cord ProlapseCord Prolapse
Cord Prolapse
mohammed sediq
 
Breech presentation and delivery
Breech presentation and deliveryBreech presentation and delivery
Breech presentation and delivery
Natangwe Tangi
 
Management of Cervical Incompetence
Management of Cervical IncompetenceManagement of Cervical Incompetence
Management of Cervical Incompetence
Kattey Kattey
 
Umbilical cord prolapse
Umbilical cord prolapseUmbilical cord prolapse
Umbilical cord prolapse
enas mostafa
 
Mellss obg y3 breech
Mellss obg y3 breechMellss obg y3 breech
Mellss obg y3 breech
nur amalina aminuddin baki
 
BREECH DELIVERY By Odokoyero Abdalah Fadhil and Nanfuka Mariam
BREECH DELIVERY By Odokoyero Abdalah Fadhil and Nanfuka MariamBREECH DELIVERY By Odokoyero Abdalah Fadhil and Nanfuka Mariam
BREECH DELIVERY By Odokoyero Abdalah Fadhil and Nanfuka Mariam
Odokonyerofadhil
 
Cord prolpase for undergraduate
Cord prolpase for undergraduateCord prolpase for undergraduate
Cord prolpase for undergraduate
Faculty of Medicine,Zagazig University,EGYPT
 
Breech Presentation
Breech PresentationBreech Presentation
Breech Presentation
Dr Manavita Mahajan
 
Breech
Breech Breech
Breech presentation
Breech presentationBreech presentation
Breech presentation
yuyuricci
 
Breech presentation
Breech presentationBreech presentation
Breech presentation
ahmed afify
 
Breech presentation for 4th year med.students
Breech presentation for 4th year med.studentsBreech presentation for 4th year med.students
Breech presentation for 4th year med.students
Dr. Aisha M Elbareg
 

What's hot (20)

Cord Prolapse
Cord ProlapseCord Prolapse
Cord Prolapse
 
Cord prolapse sasi (2)
Cord prolapse sasi (2)Cord prolapse sasi (2)
Cord prolapse sasi (2)
 
Breech presentation
Breech presentationBreech presentation
Breech presentation
 
Breech presentation
 Breech presentation Breech presentation
Breech presentation
 
Midirs Cord Prolapse
Midirs Cord ProlapseMidirs Cord Prolapse
Midirs Cord Prolapse
 
Shoulder dystocia
Shoulder dystociaShoulder dystocia
Shoulder dystocia
 
Breech presentation
Breech presentationBreech presentation
Breech presentation
 
Unstable lie
Unstable lieUnstable lie
Unstable lie
 
Cord Prolapse
Cord ProlapseCord Prolapse
Cord Prolapse
 
Breech presentation and delivery
Breech presentation and deliveryBreech presentation and delivery
Breech presentation and delivery
 
Management of Cervical Incompetence
Management of Cervical IncompetenceManagement of Cervical Incompetence
Management of Cervical Incompetence
 
Umbilical cord prolapse
Umbilical cord prolapseUmbilical cord prolapse
Umbilical cord prolapse
 
Mellss obg y3 breech
Mellss obg y3 breechMellss obg y3 breech
Mellss obg y3 breech
 
BREECH DELIVERY By Odokoyero Abdalah Fadhil and Nanfuka Mariam
BREECH DELIVERY By Odokoyero Abdalah Fadhil and Nanfuka MariamBREECH DELIVERY By Odokoyero Abdalah Fadhil and Nanfuka Mariam
BREECH DELIVERY By Odokoyero Abdalah Fadhil and Nanfuka Mariam
 
Cord prolpase for undergraduate
Cord prolpase for undergraduateCord prolpase for undergraduate
Cord prolpase for undergraduate
 
Breech Presentation
Breech PresentationBreech Presentation
Breech Presentation
 
Breech
Breech Breech
Breech
 
Breech presentation
Breech presentationBreech presentation
Breech presentation
 
Breech presentation
Breech presentationBreech presentation
Breech presentation
 
Breech presentation for 4th year med.students
Breech presentation for 4th year med.studentsBreech presentation for 4th year med.students
Breech presentation for 4th year med.students
 

Similar to Breech delivery perinatal death at Muhimbili National Hospital, Tanzania (2000-2002)

Indications and Outcomes of Emergency Caesarean Section at St Paul’s Hospital...
Indications and Outcomes of Emergency Caesarean Section at St Paul’s Hospital...Indications and Outcomes of Emergency Caesarean Section at St Paul’s Hospital...
Indications and Outcomes of Emergency Caesarean Section at St Paul’s Hospital...
Crimsonpublishers-IGRWH
 
Cesarean delivery on maternal request
Cesarean delivery on maternal requestCesarean delivery on maternal request
Cesarean delivery on maternal request
Virtual International Day of the Midwife
 
Indications and Outcomes of Emergency Caesarean Section at St Paul’s Hospital...
Indications and Outcomes of Emergency Caesarean Section at St Paul’s Hospital...Indications and Outcomes of Emergency Caesarean Section at St Paul’s Hospital...
Indications and Outcomes of Emergency Caesarean Section at St Paul’s Hospital...
Crimsonpublishers-IGRWH
 
INTERNATIONAL PUBLICATION International journal of gynecology & obstetri...
INTERNATIONAL PUBLICATION      International journal of gynecology & obstetri...INTERNATIONAL PUBLICATION      International journal of gynecology & obstetri...
INTERNATIONAL PUBLICATION International journal of gynecology & obstetri...
Dr Muhammad Mustansar
 
Birthdefect risk following assisted reproductive technology
 Birthdefect risk following assisted reproductive technology Birthdefect risk following assisted reproductive technology
Birthdefect risk following assisted reproductive technology
mothersafe
 
Clinical study of Eclampsia and outcome in a tertiary care centre
Clinical study of Eclampsia and outcome in a tertiary care centreClinical study of Eclampsia and outcome in a tertiary care centre
Clinical study of Eclampsia and outcome in a tertiary care centre
iosrjce
 
Normal and abnormal delivery 2018
Normal and abnormal delivery 2018Normal and abnormal delivery 2018
Normal and abnormal delivery 2018
gfalakha
 
A Clinical Study on Maternal and Fetal Outcome in Multiple Pregnancies in Wom...
A Clinical Study on Maternal and Fetal Outcome in Multiple Pregnancies in Wom...A Clinical Study on Maternal and Fetal Outcome in Multiple Pregnancies in Wom...
A Clinical Study on Maternal and Fetal Outcome in Multiple Pregnancies in Wom...
iosrjce
 
Management-of-Postterm-Pregnancy
Management-of-Postterm-PregnancyManagement-of-Postterm-Pregnancy
Management-of-Postterm-Pregnancy
Dr Ufaque Batool Korai
 
An investigation-of-fetal-growth-in-relation-to-pregnancy-characteristics
An investigation-of-fetal-growth-in-relation-to-pregnancy-characteristicsAn investigation-of-fetal-growth-in-relation-to-pregnancy-characteristics
An investigation-of-fetal-growth-in-relation-to-pregnancy-characteristics
Dr Max Mongelli
 
An investigation-of-fetal-growth-in-relation-to-pregnancy-characteristics
An investigation-of-fetal-growth-in-relation-to-pregnancy-characteristicsAn investigation-of-fetal-growth-in-relation-to-pregnancy-characteristics
An investigation-of-fetal-growth-in-relation-to-pregnancy-characteristics
Dr Max Mongelli
 
Hospital based study on perinatal mortality in RIMS,Manipur
Hospital based study on perinatal mortality in RIMS,ManipurHospital based study on perinatal mortality in RIMS,Manipur
Hospital based study on perinatal mortality in RIMS,Manipur
iosrjce
 
Follow up Children after Sperm Injection
Follow up Children after Sperm Injection Follow up Children after Sperm Injection
Follow up Children after Sperm Injection
Yuzko Olexandr
 
Oocyte Donation; Factors Influencing The Outcome
Oocyte Donation; Factors Influencing The Outcome�Oocyte Donation; Factors Influencing The Outcome�
Oocyte Donation; Factors Influencing The Outcome
Ulun Uluğ
 
Safety issues in assisted reproduction technology Safety issues in assisted...
Safety issues in assisted reproduction technology 	 Safety issues in assisted...Safety issues in assisted reproduction technology 	 Safety issues in assisted...
Safety issues in assisted reproduction technology Safety issues in assisted...
MedicineAndHealth14
 
E0342023026
E0342023026E0342023026
E0342023026
inventionjournals
 
ART for women over 40 years of age.pdf
ART for women over  40 years of age.pdfART for women over  40 years of age.pdf
ART for women over 40 years of age.pdf
Marmara University School of Medicine
 
stillbirth based on Williams Obstetrics, 25th Edition,2019
stillbirth based on Williams Obstetrics, 25th Edition,2019stillbirth based on Williams Obstetrics, 25th Edition,2019
stillbirth based on Williams Obstetrics, 25th Edition,2019
mohammad mahdi heidari
 
AN ANALYSIS OF OUTCOMES IN TWIN PREGNANCIES WITH ACTIVE FETAL SURVEILLANCE AN...
AN ANALYSIS OF OUTCOMES IN TWIN PREGNANCIES WITH ACTIVE FETAL SURVEILLANCE AN...AN ANALYSIS OF OUTCOMES IN TWIN PREGNANCIES WITH ACTIVE FETAL SURVEILLANCE AN...
AN ANALYSIS OF OUTCOMES IN TWIN PREGNANCIES WITH ACTIVE FETAL SURVEILLANCE AN...
Apollo Hospitals
 
Siddiqui2009
Siddiqui2009Siddiqui2009

Similar to Breech delivery perinatal death at Muhimbili National Hospital, Tanzania (2000-2002) (20)

Indications and Outcomes of Emergency Caesarean Section at St Paul’s Hospital...
Indications and Outcomes of Emergency Caesarean Section at St Paul’s Hospital...Indications and Outcomes of Emergency Caesarean Section at St Paul’s Hospital...
Indications and Outcomes of Emergency Caesarean Section at St Paul’s Hospital...
 
Cesarean delivery on maternal request
Cesarean delivery on maternal requestCesarean delivery on maternal request
Cesarean delivery on maternal request
 
Indications and Outcomes of Emergency Caesarean Section at St Paul’s Hospital...
Indications and Outcomes of Emergency Caesarean Section at St Paul’s Hospital...Indications and Outcomes of Emergency Caesarean Section at St Paul’s Hospital...
Indications and Outcomes of Emergency Caesarean Section at St Paul’s Hospital...
 
INTERNATIONAL PUBLICATION International journal of gynecology & obstetri...
INTERNATIONAL PUBLICATION      International journal of gynecology & obstetri...INTERNATIONAL PUBLICATION      International journal of gynecology & obstetri...
INTERNATIONAL PUBLICATION International journal of gynecology & obstetri...
 
Birthdefect risk following assisted reproductive technology
 Birthdefect risk following assisted reproductive technology Birthdefect risk following assisted reproductive technology
Birthdefect risk following assisted reproductive technology
 
Clinical study of Eclampsia and outcome in a tertiary care centre
Clinical study of Eclampsia and outcome in a tertiary care centreClinical study of Eclampsia and outcome in a tertiary care centre
Clinical study of Eclampsia and outcome in a tertiary care centre
 
Normal and abnormal delivery 2018
Normal and abnormal delivery 2018Normal and abnormal delivery 2018
Normal and abnormal delivery 2018
 
A Clinical Study on Maternal and Fetal Outcome in Multiple Pregnancies in Wom...
A Clinical Study on Maternal and Fetal Outcome in Multiple Pregnancies in Wom...A Clinical Study on Maternal and Fetal Outcome in Multiple Pregnancies in Wom...
A Clinical Study on Maternal and Fetal Outcome in Multiple Pregnancies in Wom...
 
Management-of-Postterm-Pregnancy
Management-of-Postterm-PregnancyManagement-of-Postterm-Pregnancy
Management-of-Postterm-Pregnancy
 
An investigation-of-fetal-growth-in-relation-to-pregnancy-characteristics
An investigation-of-fetal-growth-in-relation-to-pregnancy-characteristicsAn investigation-of-fetal-growth-in-relation-to-pregnancy-characteristics
An investigation-of-fetal-growth-in-relation-to-pregnancy-characteristics
 
An investigation-of-fetal-growth-in-relation-to-pregnancy-characteristics
An investigation-of-fetal-growth-in-relation-to-pregnancy-characteristicsAn investigation-of-fetal-growth-in-relation-to-pregnancy-characteristics
An investigation-of-fetal-growth-in-relation-to-pregnancy-characteristics
 
Hospital based study on perinatal mortality in RIMS,Manipur
Hospital based study on perinatal mortality in RIMS,ManipurHospital based study on perinatal mortality in RIMS,Manipur
Hospital based study on perinatal mortality in RIMS,Manipur
 
Follow up Children after Sperm Injection
Follow up Children after Sperm Injection Follow up Children after Sperm Injection
Follow up Children after Sperm Injection
 
Oocyte Donation; Factors Influencing The Outcome
Oocyte Donation; Factors Influencing The Outcome�Oocyte Donation; Factors Influencing The Outcome�
Oocyte Donation; Factors Influencing The Outcome
 
Safety issues in assisted reproduction technology Safety issues in assisted...
Safety issues in assisted reproduction technology 	 Safety issues in assisted...Safety issues in assisted reproduction technology 	 Safety issues in assisted...
Safety issues in assisted reproduction technology Safety issues in assisted...
 
E0342023026
E0342023026E0342023026
E0342023026
 
ART for women over 40 years of age.pdf
ART for women over  40 years of age.pdfART for women over  40 years of age.pdf
ART for women over 40 years of age.pdf
 
stillbirth based on Williams Obstetrics, 25th Edition,2019
stillbirth based on Williams Obstetrics, 25th Edition,2019stillbirth based on Williams Obstetrics, 25th Edition,2019
stillbirth based on Williams Obstetrics, 25th Edition,2019
 
AN ANALYSIS OF OUTCOMES IN TWIN PREGNANCIES WITH ACTIVE FETAL SURVEILLANCE AN...
AN ANALYSIS OF OUTCOMES IN TWIN PREGNANCIES WITH ACTIVE FETAL SURVEILLANCE AN...AN ANALYSIS OF OUTCOMES IN TWIN PREGNANCIES WITH ACTIVE FETAL SURVEILLANCE AN...
AN ANALYSIS OF OUTCOMES IN TWIN PREGNANCIES WITH ACTIVE FETAL SURVEILLANCE AN...
 
Siddiqui2009
Siddiqui2009Siddiqui2009
Siddiqui2009
 

Recently uploaded

Hemodialysis: Chapter 5, Dialyzers Overview - Dr.Gawad
Hemodialysis: Chapter 5, Dialyzers Overview - Dr.GawadHemodialysis: Chapter 5, Dialyzers Overview - Dr.Gawad
Hemodialysis: Chapter 5, Dialyzers Overview - Dr.Gawad
NephroTube - Dr.Gawad
 
KENT'S REPERTORY by dr niranjan mohanty.pptx
KENT'S REPERTORY by dr niranjan mohanty.pptxKENT'S REPERTORY by dr niranjan mohanty.pptx
KENT'S REPERTORY by dr niranjan mohanty.pptx
SravsPandu1
 
Pharmacology of Drugs for Congestive Heart Failure
Pharmacology of Drugs for Congestive Heart FailurePharmacology of Drugs for Congestive Heart Failure
Pharmacology of Drugs for Congestive Heart Failure
Dr. Nikhilkumar Sakle
 
biomechanics of running. Dr.dhwani.pptx
biomechanics of running.   Dr.dhwani.pptxbiomechanics of running.   Dr.dhwani.pptx
biomechanics of running. Dr.dhwani.pptx
Dr. Dhwani kawedia
 
Pollen and Fungal allergy: aeroallergy.pdf
Pollen and Fungal allergy: aeroallergy.pdfPollen and Fungal allergy: aeroallergy.pdf
Pollen and Fungal allergy: aeroallergy.pdf
Chulalongkorn Allergy and Clinical Immunology Research Group
 
Helminthiasis or Worm infestation in Children for Nursing students
Helminthiasis or Worm infestation in Children for Nursing studentsHelminthiasis or Worm infestation in Children for Nursing students
Helminthiasis or Worm infestation in Children for Nursing students
RAJU B N
 
Call Girl Pune 7339748667 Vip Call Girls Pune
Call Girl Pune 7339748667 Vip Call Girls PuneCall Girl Pune 7339748667 Vip Call Girls Pune
Call Girl Pune 7339748667 Vip Call Girls Pune
Mobile Problem
 
Nano-gold for Cancer Therapy chemistry investigatory project
Nano-gold for Cancer Therapy chemistry investigatory projectNano-gold for Cancer Therapy chemistry investigatory project
Nano-gold for Cancer Therapy chemistry investigatory project
SIVAVINAYAKPK
 
Call Girls Lucknow 9024918724 Vip Call Girls Lucknow
Call Girls Lucknow 9024918724 Vip Call Girls LucknowCall Girls Lucknow 9024918724 Vip Call Girls Lucknow
Call Girls Lucknow 9024918724 Vip Call Girls Lucknow
nandinirastogi03
 
pharmacology for dummies free pdf download.pdf
pharmacology for dummies free pdf download.pdfpharmacology for dummies free pdf download.pdf
pharmacology for dummies free pdf download.pdf
KerlynIgnacio
 
NARCOTICS- POLICY AND PROCEDURES FOR ITS USE
NARCOTICS- POLICY AND PROCEDURES FOR ITS USENARCOTICS- POLICY AND PROCEDURES FOR ITS USE
NARCOTICS- POLICY AND PROCEDURES FOR ITS USE
Dr. Ahana Haroon
 
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7
shruti jagirdar
 
Pune Call Girls 7339748667 AVAILABLE HOT GIRLS AUNTY BOOK NOW
Pune Call Girls 7339748667 AVAILABLE HOT GIRLS AUNTY BOOK NOWPune Call Girls 7339748667 AVAILABLE HOT GIRLS AUNTY BOOK NOW
Pune Call Girls 7339748667 AVAILABLE HOT GIRLS AUNTY BOOK NOW
Get New Sim
 
Demystifying Fallopian Tube Blockage- Grading the Differences and Implication...
Demystifying Fallopian Tube Blockage- Grading the Differences and Implication...Demystifying Fallopian Tube Blockage- Grading the Differences and Implication...
Demystifying Fallopian Tube Blockage- Grading the Differences and Implication...
FFragrant
 
13. PROM premature rupture of membranes
13.  PROM premature rupture of membranes13.  PROM premature rupture of membranes
13. PROM premature rupture of membranes
TigistuMelak
 
Tele Optometry (kunj'sppt) / Basics of tele optometry.
Tele Optometry (kunj'sppt) / Basics of tele optometry.Tele Optometry (kunj'sppt) / Basics of tele optometry.
Tele Optometry (kunj'sppt) / Basics of tele optometry.
Kunj Vihari
 
Nutritional deficiency disorder in Child
Nutritional deficiency disorder in ChildNutritional deficiency disorder in Child
Nutritional deficiency disorder in Child
Bhavyakelawadiya
 
Patellar Instability: Diagnosis Management
Patellar Instability: Diagnosis  ManagementPatellar Instability: Diagnosis  Management
Patellar Instability: Diagnosis Management
Dr Nitin Tyagi
 
Gene Expression System-viral gene delivery Mpharm(Pharamaceutics)
Gene Expression System-viral gene delivery Mpharm(Pharamaceutics)Gene Expression System-viral gene delivery Mpharm(Pharamaceutics)
Gene Expression System-viral gene delivery Mpharm(Pharamaceutics)
MuskanShingari
 
Full Handwritten notes of RA by Ayush Kumar M pharm - Al ameen college of pha...
Full Handwritten notes of RA by Ayush Kumar M pharm - Al ameen college of pha...Full Handwritten notes of RA by Ayush Kumar M pharm - Al ameen college of pha...
Full Handwritten notes of RA by Ayush Kumar M pharm - Al ameen college of pha...
ayushrajshrivastava7
 

Recently uploaded (20)

Hemodialysis: Chapter 5, Dialyzers Overview - Dr.Gawad
Hemodialysis: Chapter 5, Dialyzers Overview - Dr.GawadHemodialysis: Chapter 5, Dialyzers Overview - Dr.Gawad
Hemodialysis: Chapter 5, Dialyzers Overview - Dr.Gawad
 
KENT'S REPERTORY by dr niranjan mohanty.pptx
KENT'S REPERTORY by dr niranjan mohanty.pptxKENT'S REPERTORY by dr niranjan mohanty.pptx
KENT'S REPERTORY by dr niranjan mohanty.pptx
 
Pharmacology of Drugs for Congestive Heart Failure
Pharmacology of Drugs for Congestive Heart FailurePharmacology of Drugs for Congestive Heart Failure
Pharmacology of Drugs for Congestive Heart Failure
 
biomechanics of running. Dr.dhwani.pptx
biomechanics of running.   Dr.dhwani.pptxbiomechanics of running.   Dr.dhwani.pptx
biomechanics of running. Dr.dhwani.pptx
 
Pollen and Fungal allergy: aeroallergy.pdf
Pollen and Fungal allergy: aeroallergy.pdfPollen and Fungal allergy: aeroallergy.pdf
Pollen and Fungal allergy: aeroallergy.pdf
 
Helminthiasis or Worm infestation in Children for Nursing students
Helminthiasis or Worm infestation in Children for Nursing studentsHelminthiasis or Worm infestation in Children for Nursing students
Helminthiasis or Worm infestation in Children for Nursing students
 
Call Girl Pune 7339748667 Vip Call Girls Pune
Call Girl Pune 7339748667 Vip Call Girls PuneCall Girl Pune 7339748667 Vip Call Girls Pune
Call Girl Pune 7339748667 Vip Call Girls Pune
 
Nano-gold for Cancer Therapy chemistry investigatory project
Nano-gold for Cancer Therapy chemistry investigatory projectNano-gold for Cancer Therapy chemistry investigatory project
Nano-gold for Cancer Therapy chemistry investigatory project
 
Call Girls Lucknow 9024918724 Vip Call Girls Lucknow
Call Girls Lucknow 9024918724 Vip Call Girls LucknowCall Girls Lucknow 9024918724 Vip Call Girls Lucknow
Call Girls Lucknow 9024918724 Vip Call Girls Lucknow
 
pharmacology for dummies free pdf download.pdf
pharmacology for dummies free pdf download.pdfpharmacology for dummies free pdf download.pdf
pharmacology for dummies free pdf download.pdf
 
NARCOTICS- POLICY AND PROCEDURES FOR ITS USE
NARCOTICS- POLICY AND PROCEDURES FOR ITS USENARCOTICS- POLICY AND PROCEDURES FOR ITS USE
NARCOTICS- POLICY AND PROCEDURES FOR ITS USE
 
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7
 
Pune Call Girls 7339748667 AVAILABLE HOT GIRLS AUNTY BOOK NOW
Pune Call Girls 7339748667 AVAILABLE HOT GIRLS AUNTY BOOK NOWPune Call Girls 7339748667 AVAILABLE HOT GIRLS AUNTY BOOK NOW
Pune Call Girls 7339748667 AVAILABLE HOT GIRLS AUNTY BOOK NOW
 
Demystifying Fallopian Tube Blockage- Grading the Differences and Implication...
Demystifying Fallopian Tube Blockage- Grading the Differences and Implication...Demystifying Fallopian Tube Blockage- Grading the Differences and Implication...
Demystifying Fallopian Tube Blockage- Grading the Differences and Implication...
 
13. PROM premature rupture of membranes
13.  PROM premature rupture of membranes13.  PROM premature rupture of membranes
13. PROM premature rupture of membranes
 
Tele Optometry (kunj'sppt) / Basics of tele optometry.
Tele Optometry (kunj'sppt) / Basics of tele optometry.Tele Optometry (kunj'sppt) / Basics of tele optometry.
Tele Optometry (kunj'sppt) / Basics of tele optometry.
 
Nutritional deficiency disorder in Child
Nutritional deficiency disorder in ChildNutritional deficiency disorder in Child
Nutritional deficiency disorder in Child
 
Patellar Instability: Diagnosis Management
Patellar Instability: Diagnosis  ManagementPatellar Instability: Diagnosis  Management
Patellar Instability: Diagnosis Management
 
Gene Expression System-viral gene delivery Mpharm(Pharamaceutics)
Gene Expression System-viral gene delivery Mpharm(Pharamaceutics)Gene Expression System-viral gene delivery Mpharm(Pharamaceutics)
Gene Expression System-viral gene delivery Mpharm(Pharamaceutics)
 
Full Handwritten notes of RA by Ayush Kumar M pharm - Al ameen college of pha...
Full Handwritten notes of RA by Ayush Kumar M pharm - Al ameen college of pha...Full Handwritten notes of RA by Ayush Kumar M pharm - Al ameen college of pha...
Full Handwritten notes of RA by Ayush Kumar M pharm - Al ameen college of pha...
 

Breech delivery perinatal death at Muhimbili National Hospital, Tanzania (2000-2002)

  • 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