Why not plan an elective Caesarean section for breech presentation at term – safety first?

Background: Caesarean delivery is defined as the birth of the foetus through an incision in the abdominal wall (i.e. laparotomy) and the uterine wall (hysterotomy). The purpose was to analyze the maternal and foetal outcome in elective versus emergency caesarean sections retrospectively in a tertiary care centre and to analyze the indications of elective versus emergency caesarean sections.Methods: A retrospective observational study of the cases undergoing caesarean sections in KEM hospital, Mumbai, India was carried out during the period of September 2013 to September 2015. Maternal and foetal outcome was studied. The data was collected and analyzed from the maternal medical records. The neonatology records were also examined.Results: Out of the 600 selected patients, 300 patients in each group of elective and emergency caesarean section were studied. The usual indications of emergency caesarean sections were foetal distress, followed by meconium stained amniotic fluid (MSAF) and cephalopelvic disproportion (CPD). The most frequent indicator for elective lower segment caesarean section (LSCS) was patient with previous LSCS not willing for vaginal birth, followed by breech presentation and previous multiple LSCS. There was a significant difference seen in the occurrence of fever, urinary tract infections and wound infections in the two groups. These were more common in the emergency caesarean section group. Significant difference was also seen in the incidence of postpartum haemorrhage in the two groups, which was more in the elective caesarean section group.Conclusions: The maternal morbidity, intra operative and postoperative complications were more in the emergency LSCS group as compared to patients who underwent elective LSCS.

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Vaginal Delivery versus Elective Caesarean Section for Breech Presentation - Experience in Institute of Child and Mother Health (ICMH)

Medicine Today ◽

10.3329/medtoday.v31i1.40317 ◽

2019 ◽

Vol 31 (1) ◽

pp. 23-26

Author(s):

Mahe Jabeen ◽

Sabiha Shimul ◽

Ummay Salma ◽

Jebunnesa

Keyword(s):

Caesarean Section ◽

Vaginal Delivery ◽

Maternal Morbidity ◽

Neonatal Outcome ◽

Elective Caesarean Section ◽

Tertiary Care ◽

Mode Of Delivery ◽

Breech Presentation ◽

Cost Of Care ◽

Increased Risk

Introduction: Compared with a fetus with cephalic presentation, a breech fetus faces increased risk during labour and delivery of asphyxia from cord compression and of traumatic injury during delivery of the shoulders and head. Caesarean section avoids most of this risk. The purpose of this study was to evaluate the feasibility of vaginal delivery of uncomplicated singleton breech presentation by evaluating early neonatal morbidity and mortality as well as maternal morbidity following vaginal and caesarean delivery for breech presentation. Materials and Methods: This is a cross sectional comparative study.104 women with singleton breech presentation at term in labour were included consequetively in labour ward of Institute of Child and Mother Health (ICMH). Informed consent was taken from them. Neonatal and maternal outcome were recorded and statistical analysis was done using SPSS version 22. Results: APGAR at 5 min and Neonatal Intensive Care Unite (NICU) admission were not affected by mode of delivery. Long term neonatal outcome is similar in either mode of delivery. Maternal morbidity and duration of hospital stay is increased in caesarean births. Conclusion: Neonatal outcome did not depend on mode of delivery though maternal morbidity and cost of care is increased following Caesarean Section. Proper selection of cases and by improving skill & confidence in new generation obstetrician, vaginal delivery of singleton fetuses in breech presentation at term remains a safe option that can be offered to a woman in a tertiary care centre. Medicine Today 2019 Vol.31(1): 23-26

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Prevalence of Caesarean Section in Matri Shishu Miteri Hospital of Gandaki Province

Medical Journal of Pokhara Academy of Health Sciences ◽

10.3126/mjpahs.v3i1.31925 ◽

2020 ◽

Vol 3 (1) ◽

pp. 244-248

Author(s):

Prem Raj Pageni ◽

Rajesh Adhikari ◽

Padma Raj Dhungana ◽

Deepak Raj Kafle

Keyword(s):

Caesarean Section ◽

Elective Caesarean Section ◽

Breech Presentation ◽

Fetal Distress ◽

Time Frame ◽

World Health ◽

Clinical Indication ◽

Age Group ◽

The Common ◽

Failed Induction

Background: Caesarean section (CS) is one of the commonest obstetrics procedure to reduce the risks for mother and fetus when vaginal delivery is not anticipated. The objective of the study was to determine the rate and clinical indication of Caesarean section. Materials and Methods: This was a hospital based descriptive retrospective study done within a time frame of a year (from Shrawan 2075 BS to Ashad 2076 BS; 17 July 2018 to July 16 2019) in Matri Shishu Miteri Hospital, Pokhara, Nepal. The total number of deliveries, their modes of delivery, indication for the Cesarean section, age group, number of parity, period of gestation and type of Caesarean section either elective or emergency were descriptively analyzed. Results: A total of five hundred and eighty eight cases underwent delivery during the study period. Of them 128 (21.76%) cases were delivered by Caesarean section. Analysis revealed that the common age group for the CS patients was between 20-30 years (64.8%) of them 66 (51.6%) cases were primi gravida. Emergency Caesarean section was done for 75(58.6%) cases and elective Caesarean section for 53(41.4%) cases. The most common indication for Caesarean section was found to be previous caesarean section 21% (n=27), cephalopelvic disproportion (CPD) 18% (n=23), fetal distress 18% (n=23), failed induction 14.1% (n=18), breech presentation 10.2 %( n=13), non progress of labor (NPOL) 9.4 %( n=12) and oligohydramnios 7.8% (n=10). Conclusion: Our study revealed that the rate of Caesarean section is higher than that recommended by World Health Organization (WHO), which needed to be 10-15% of the total deliveries. The common indications for Caesarean sections were pervious Caesarean section, fetal distress, CPD, failed induction, breech presentation, non progress of labour (NPOL) and oligohydramnios among others.

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Breech presentation at term: Caesarean section or vaginal delivery?

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1104155d ◽

2011 ◽

Vol 139 (3-4) ◽

pp. 155-160

Author(s):

Janko Djuric ◽

Slobodan Arsenijevic ◽

Dragic Bankovic ◽

Zoran Protrka ◽

Marija Sorak ◽

...

Keyword(s):

Caesarean Section ◽

Vaginal Delivery ◽

Body Mass ◽

Head Circumference ◽

Apgar Score ◽

Elective Caesarean Section ◽

Breech Presentation ◽

Level Of Education ◽

Minute Apgar Score

Introduction. Term breech presentation occurs in 3-4% of all deliveries. Most obstetricians are completely sure how to end delivery when the foetus is in breech presentation, by caesarean section as the only option. Objective. The main goal of the paper was to present the method of delivery for term breech presentation analyzed at the Hospital of Gynaecology and Obstetrics and Clinical Centre in Kragujevac, and parameters that influenced the decision on the method of choice to perform delivery with the foetus in breech position. Methods. During a three-year prospective study, the course and outcome of all term breech deliveries were under follow-up. The study involved only deliveries in breech presentation, with a trial of labour ending by vaginal delivery, while elective caesarean section due to breech presentation of the foetus was not included in the study. The following parameters were compared: body mass, newborn?s first minute Apgar score and head circumference, gestational maturity, gestational age, delivery duration, maternal level of education and maternal parity. Results. Of total 6,470 deliveries, 653 (10.10%) were finalized by caesarean section. Of these, there were 202 (3.12%) term breech presentations, of which 72 (35.64%) women had caesarean and 130 (64.36%) vaginal delivery. A difference was detected in newborn?s body mass and head circumference, delivery duration, maternal level of education and parity between pregnancies terminated surgically in comparison to vaginal delivery, while pregnancy duration, maternal age, first minute Apgar score, and most significantly, perinatal morbidity did not show any difference regardless of the method of delivery for term breech presentation. Conclusion. With respect of all known parameters, vaginal delivery in breech presentation is also accepted.

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Leiomyosarcoma in pregnancy: Incidental finding during routine caesarean section

Clinical Journal of Obstetrics and Gynecology ◽

10.29328/journal.cjog.1001094 ◽

2021 ◽

Vol 4 (3) ◽

pp. 092-095

Author(s):

Tang Toon Wen ◽

Jessie Phoon Wai Leng

Keyword(s):

Caesarean Section ◽

Reproductive Tract ◽

Incidental Finding ◽

Elective Caesarean Section ◽

Breech Presentation ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Female Reproductive Tract ◽

Uterine Leiomyosarcoma ◽

In Pregnancy

Uterine leiomyosarcoma (LMS) is uncommon tumour arising from the female reproductive tract. Incidence of LMS in pregnancy is extremely rare, with only 10 cases reported thus far in medical literature. We present a case of myomectomy performed during elective caesarean section for breech presentation, due to its easy accessibility and well contracted uterus. Subsequent histology revealed LMS on final specimen. Patient subsequently underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy. No chemotherapy was given as she opted for close clinical- radiological monitoring instead. This case report highlights the importance of discussion with patients regarding the risk of occult malignancy in a fibroid uterus. Appropriate management of uterine leiomyosarcoma in pregnancy remains unclear. Consideration of removing an enlarging leiomyoma during caesarean section might be ideal in view of its malignant potential, just like in this case; however, location of the tumour and risk of bleeding needs to be weighed. Ultimately, management of such cases needs proper discussion between obstetrician and the patient.

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Breech Presentation Among Nullipara at Term: An Indication for Caesarean Section

Kathmandu University Medical Journal ◽

10.3126/kumj.v10i4.10998 ◽

2014 ◽

Vol 10 (4) ◽

pp. 66-69

Author(s):

A Dongol ◽

S Regmi ◽

S Manandhar ◽

S KC

Keyword(s):

Caesarean Section ◽

Analytical Study ◽

Post Partum ◽

Elective Caesarean Section ◽

Mode Of Delivery ◽

Breech Presentation ◽

University Hospital ◽

Breech Delivery ◽

Maternal Morbidity And Mortality ◽

Route Of Delivery

Background Breech is the commonest malpresentation. Vaginal breech delivery in a nulliparous lady carries higher risk than in multiparous ladies. Poor neonatal outcome following vaginal delivery has made the mode of delivery a matter of controversy. Objective To evaluate the outcome of planned caesarean section among nullipara ladies with breech presentation. Method This is a prospective, analytical study conducted in Dhulikhel Hospital Kathmandu University Hospital from January 2008 to June 2012 among 102 nullipara ladies at term gestation with breech presentation. All cases underwent caesarean section either elective or emergency. During section cause of breech presentation was searched for. Neonatal condition was evaluated using APGAR Score, need for resuscitation and admission in NICU. Post partum status was also recorded for evaluation of maternal morbidity and mortality. Results These Nullipara ladies often had some reason for breech presentation, the most common being cord around the neck. Perinatal outcome was uneventful in 97(95%) neonates, there were two (2%) still birth and three (3%) needed NICU care. APGAR was good in 92 neonates, average in eight and poor in two. Total 16(15.6%) ladies stayed hospital for more than eight days. Among them 11(10.7%) developed wound infection and five stayed in hospital waiting for baby. Conclusion Nullipara ladies with breech presentation should have elective caesarean section as a preferred route of delivery. DOI: http://dx.doi.org/10.3126/kumj.v10i4.10998 Kathmandu Univ Med J 2012;10(4):66-69

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VAGINAL BREECH DELIVERY

The Professional Medical Journal ◽

10.29309/tpmj/2015.22.08.1149 ◽

2015 ◽

Vol 22 (08) ◽

pp. 1024-1028

Author(s):

Samina Naz

Keyword(s):

Caesarean Section ◽

Vaginal Delivery ◽

Perinatal Death ◽

Elective Caesarean Section ◽

Breech Presentation ◽

Neurological Dysfunction ◽

Breech Delivery ◽

Vaginal Breech Delivery ◽

Group A ◽

Group B

Objective: To determine the obstetric and perinatal outcome of pregnancieswith singleton breech presentation, and to scrutinize the causes of increasing incidence ofcesarean section in breech presentation. Design: Analytical Observational study. Place andduration: Department of obstetrics and gynecology Fatima hospital Baqai university campusfrom Jan 2010 to Oct 2011. Patients & Methods: This study includes 135 patients with singletonbreech presentation ≥ 34 weeks of gestation, were analyzed in detail with help of designedperforma. Patients were categorized in three groups. Groups a, who had elective C-section,group b. who underwent emergency caesarean section or had C-section after failed trial ofvaginal delivery and group c. who had vaginal breech delivery. Elective caesarean section wasdone in those cases that had some other indications for carrying out this procedure apart frombreech presentation. Trial of vaginal breech delivery was planned for all multiparous womenexcept those falling in group A. All antepartum fetal demise, twin pregnancies and placentaprevia of major degree were excluded. Results: Of 135 women, 7(5%) underwent prelabourcesarean, and 128(95%), had trial of vaginal delivery, of whom 117(91.5%) delivered vaginally.Significantly more infants weighing> 3.5kg were selected for prelabour and intrapartumcesarean than vaginal delivery. Two neonates had Apgar score< 7 at 5 minutes but both werenormal neurologically. There were no nonanomalous perinatal death and no case of significanttrauma or neurological dysfunction. Two infants died due to lethal anomalies. Conclusion:Trial of vaginal breech delivery in well counselled patients, still taken as an appropriate optionwithout compromising prenatal and maternal outcome. It also decreases the rate of cesareansection.

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