Mode of delivery in breech presentation and neonatal birth asphyxia- an observational study at Seti Provincial Hospital

Abstract Background Breech presentation is the commonest malpresentation (3–4% of singleton pregnancy). Mode of delivery in breech presentation has remained a controversy till date, the higher neonatal morbidity and mortality associated with vaginal mode of delivery and its impact on raising the rate of cesarean section is significant. The relationship of mode of delivery and neonatal morbidity and mortality is most important information sought in this topic which may be different based on clinical setting and skill. Although cesarean delivery is preferable for term breech infants owing to better perinatal results, some selected patients can be delivered vaginally. Thus, this research aims to compare NICU admission and asphyxia between term breech infants delivered vaginally and via cesarean delivery. Methods A prospective observational study was conducted among women with breech presentation delivering at Seti Provincial Hospital from may 2022 to Feb 2023 The study population was Women with breech presentation who met the eligibility criteria were consecutively enrolled. Women with preterm birth before 34 weeks, multiple pregnancy, previous cesarean section, or another indication for cesarean delivery were excluded. Neonatal outcomes were compared between the two groups. For bivariate analysis chi-square test and simple binary logistic regression was performed and multiple binary logistic regression was performed for multivariate analysis. Results Among 463 women with breech presentation, 228 (49.2%) had vaginal delivery and 235 (50.8%) underwent cesarean delivery. A 5-minute Apgar score < 7 occurred in 9.2% of neonates following vaginal delivery compared with 2.1% following cesarean delivery (p = 0.004). NICU admission occurred in 8.8% and 2.6% of neonates, respectively (p < 0.001) in vaginal and cesarean delivery. After adjustment, vaginal delivery was associated with higher odds of NICU admission, although the association was not statistically significant (aOR 2.10, p = 0.145). Cesarean delivery was independently associated with higher odds of a normal 5-minute Apgar score (aOR 3.02, p = 0.039. Conclusion In this cohort of women with breech presentation, vaginal breech delivery was associated with higher neonatal morbidity, reflected by lower 5-minute Apgar scores and increased NICU admission. Careful case selection and appropriate intrapartum and neonatal care are essential for optimizing outcomes.