Outcome of singleton breech deliveries beyond 28 weeks gestation: the experience at MCH Centre, PIMS. Mother and Child Health. Pakistan Institute of Medical Sciences.

OBJECTIVE To conduct an audit of breech deliveries at or beyond 28 weeks gestation to determine the neonatal outcome at different gestations in relation to the mode of delivery. SETTING MCH Centre, PIMS, Islamabad. SUBJECTS AND METHODS Records of 171 consecutive singleton breech deliveries > or = 28 weeks gestation were retrieved and stratified into 3 groups by gestational age, 28-33 completed weeks, 34-36 completed weeks and beyond 37 weeks. The main outcome measures were the incidence of perinatal morbidity and mortality of the three gestation groups in relation to the mode of delivery. RESULTS Of 171 cases, 20 women (11.7%) delivered at 28 to 33 weeks, 17 of whom were delivered vaginally. The main birth weight (MBW) was 1.4 kg. Perinatal deaths occurred in 15 cases, these included 4 intrauterine deaths (IUDs) and 6 infants with congenital anomalies. Thirty three women (19.3%) delivered at 34 to 36 weeks gestation, of whom 17 (51.5%) delivered vaginally. The MBW was 2 kg with 6 perinatal deaths (one with cephalhaematoma and 4 IUD and 2 congenital anomalies). Sixteen women (48.5%) had caesarean sections. The MBW was 2.2 kg with only 2 perinatal deaths due to IUD and congenital pneumonia. One hundred and eighteen (69%) women delivered at term. The MBW of the 45 (38.1%) vaginally delivered infants was 2.2 kg with 9 perinatal deaths (1 IUD and 7 congenital anomalies). Seventy three (61.9%) had caesarean sections, 41 emergency and 32 elective. The MBW was 2.9 kg with 4 perinatal deaths (1 IUD, 2 congenital anomalies and 1 sepsis). CONCLUSION There was significant association of breech presentation with congenital anomalies. After the exclusion of congenital anomalies, greater recourse to caesarean section beyond 34 weeks seems to confer a survival advantage to the new born infant.