Perinatal death and mode of delivery among term singleton breech births: A retrospective cohort study at a tertiary hospital in Ghana

Abstract Objective To quantify the burden of perinatal death and identify factors associated with perinatal death and with cesarean delivery among term singleton breech births at Cape Coast Teaching Hospital, Ghana. Methods This retrospective cohort study included term singleton breech births with documented fetal cardiac activity at admission from 2015 to 2021; antepartum stillbirths were excluded. Multivariable logistic regression examined factors associated with perinatal death. Mixed‐effects logistic regression, with a random intercept for delivery year, examined factors associated with cesarean delivery. Adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs) are reported. Results Among 695 eligible births, 542 (78.0%) were by cesarean delivery. There were 41 perinatal deaths (5.9%; 59.0 per 1000 births), comprising 25 intrapartum stillbirths and 16 early neonatal deaths. Perinatal death occurred in 32 of 153 vaginal breech births (20.9%) and in nine of 542 cesarean deliveries (1.7%). These figures describe outcomes according to actual rather than intended mode of delivery and should not be interpreted causally or as a comparison of planned delivery strategies. Higher parity was associated with increased odds of perinatal death (aOR = 1.32, 95% CI = 1.04–1.68). Older maternal age was associated with higher odds of cesarean delivery (aOR = 1.04, 95% CI = 1.005–1.09), whereas higher parity was associated with lower odds of cesarean delivery (aOR = 0.72, 95% CI = 0.63–0.83). Conclusion The burden of perinatal death was substantial among term singleton breech births at this Ghanaian tertiary hospital. Most deaths were intrapartum stillbirths. Strengthening antenatal detection, timely referral, intrapartum care, operative readiness, neonatal care, and proficiency in emergency vaginal breech birth may improve outcomes.