comparison of outcome of diagnosed versus undiagnosed breech at term in labour

ABSTRACT

To assess the proportion of undiagnosed breech presentation in labour and to compare their mode of delivery and outcome with those diagnosed prior to onset of labour. This comparative study was conducted in the department of Obstetrics and Gynaecology unit I, at Holy Family Hospital Rawalpindi. January 2001 to June2002. Low risk singleton breech presentation, 50 diagnosed and 50 undiagnosed cases in labour were selected to compare their mode of delivery and outcome. All high risk cases with breech presentation associated with complications or major congenital abnormalities were excluded. Outcome measures were assessed in form of Apgar score, birth injuries and neonatal deaths. Maternal morbidity was also assessed in term of infectious morbidity and duration of hospital stay 70% cases were selected for elective caesarean section in diagnosed group and 10%in the undiagnosed group. 54% of babies delivered by caesarean section weighed more than 3.5kg. There was no difference in perinatal morbidity and mortality. Maternal morbidity, and duration of hospital stay increased considerably in diagnosed group. Significant number of breech presentations remain undiagnosed because of lack of antenatal care and are more likely to deliver vaginally without any significant difference in neonatal mortality and morbidity. Caesarean section of selected cases of breech presentations is associated with increased maternal morbidity in both groups without corresponding improvement in neonatal outcome: