Outcome of 441 breech singleton deliveries at the Catholic Hospital, Oluyoro, Ibadan.

Breech presentation at delivery occurred in 441 of 21,243 deliveries giving an incidence of 2.1% in Oluyoro Catholic Hospital, Ibadan. The fresh stillbirth rate was 7.8% and this was six times the cephalic (1.2%) fresh stillbirth rate for the same period. The incidence of breech presentation was lowest between parity 1 and 3, and rose above parity 5. Majority of the stillbirths occurred in primigravidae and grandmultiparous patients. Caesarean section was performed in 15.7% of breech singleton, while 79% were delivered by assisted breech delivery. The commonest indication for caesarean section was fetal distress. Low birth weight (2.5 kg) or less breech singleton occurred in 22% cases, and accounted for 45% of all breech stillbirths. The lowest risk to the fetus was between 3kg and 4kg birth weights. Congenital abnormalities of the Central Nervous System occurred in 2.7% of breech babies as compared to 0.2% in cephalic presentation. Low birth weight, prematurity, primigravidity and grandmultiparity were the identified factors associated with stillbirths. Early identification and management of these factors will reduce the high incidence of perinatal deaths in breech deliveries. We advocate the use of symphysiotomy in the management of the entrapped aftercoming head of the breech.

Efficacy of large loop excision of the transformation zone for cervical intraepithelial neoplasia.

This study showed the efficacy of large loop excision of the transformation zone (LLETZ) in the management of cervical intraepithelial neoplasia (CIN). Eighty-three women with abnormal cervical cytology were recruited. Colposcopic examination and directed punch biopsy were performed and the women had LLETZ therapy as an outpatient procedure. There were 2 cases of microinvasive cervical carcinoma that were missed by directed punch biopsy, the diagnosis being made after the patients underwent LLETZ treatment. There was a large disparity in the histological analysis between directed punch biopsy and LLETZ specimen. This disparity would not have been detected if the women were treated by ablative methods. In women with cervical dysplasia, LLETZ procedure is preferred as the whole excised lesion can be examined histologically and diagnostic error is reduced.