An Audit of Breech Presentation at a District Level Hospital

Abstract

Introduction: The term Breech Trial has led to obstetricians opting for caesarean section as the mode of delivery for this presentation, even in poor countries. The concerns of this approach are the resultant increase in caesarean section rates and their associated complications, particularly in under-resourced countries, which are faced with financial and human resource expertise constraints. Method: This was a retrospective chart review of women who presented at term with a singleton breech presentation at the antenatal and in labour, from January 2005 – December 2007. Results: There was a total of 19,197 deliveries, of which 466 were singleton term breech deliveries, giving a rate of 2.4%. Of the 297 women who had antenatal care and had been allocated to planned caesarean section, 271 had the planned operation. There were no neonatal deaths in the planned caesarean section group. The emergency caesarean section group and the group in which no decision was made on the mode of delivery, were associated with a higher maternal complication rate than those who had planned caesarean sections. The highest neonatal complication rate was in those who had unplanned vaginal delivery. Conclusion: In a district hospital in South Africa, the mode of delivery is usually a planned caesarean section. Unplanned vaginal deliveries are associated with significant perinatal mortality.