Outcome of breech deliveries in nulliparous women

Background: Compared to cephalic presentation with respect to fetal morbidity and mortality, breech delivery management was a high risk. Aim: To evaluate the outcome of breech deliveries in nulliparous women. Materials and methods: This was a retrospective study conducted from October 2012 till September 2015 .The study was conducted at Government hospital Nizabmabad and CKM hospital, Warangal. The selection criteria were gestational age ≥ 32 weeks which was validated by ultrasound examination performed before 20 weeks gestation when calculated from last menstrual period, a singleton with breech presentation and normal fetal heart beats in nulliparous women. Adequate pelvis, frank or complete breech, estimated weight of foetus lesser than 3500 grams, no other obstetric complication were the inclusion criteria. Results: During these 3 years survey, 12000 deliveries were done. Out of which, 3000 were nulliparous, and there were 400 cases of breech presentation, and there was an incidence of 3.33%. A total of 250 women met the inclusion criteria and had undergone delivery by VBD or by Caesarean section. There were 120 caesarean deliveries, of which 56 (46.66%) were elective and 64 (53.33%) were emergencies. The main indication for emergency CS was acute foetal distress accounting to 42 (65.63%) cases. The main indication for elective CS was foetal birth weight ≥3500 grams accounting to 25 (44.64%) cases. Out of 130, 15 (11.54%) neonates had poor APGAR score (<7) at the 5th minute of birth. In elective caesarean section, none had poor APGAR score at 5th minute. In emergency, caesarean section, 6 (9.38%) had a poor APGAR score at the 5th minute. Out of the 6 cases, the indication for the emergency caesarean section was acute foetal distress, 2 in 35 years old patients carrying foetus of 3300 grams and 3200 grams, others had cord prolapsed. In APGAR score between the group of elective and emergency caesarean section, there was a statistically significant difference in the mean 5th minute. Conclusion: It can be concluded from this study that in cases of inadequate pelvis, foetal weight ≥3500 grams or ≤1800 grams, footling breech presentation, post term pregnancies, vaginal breech delivery is unsafe.