Perinatal outcome in breech presentation depending on the mode of vaginal delivery

Abstract

Aim: To compare the influence of different modes of vaginal delivery in breech presentation on perinatal outcome.

Materials and methods: During the period 2000-2005, perinatal outcome of newborns was compared in 144 vaginal breech deliveries divided into 5 groups depending on the mode of delivery used (Bracht, Thiessen, Muller, Mauriceau-Levret-Veit-Smellie (MLVS), classical arm release). Neonates transferred to the neonatal intensive care unit were further divided into 2 groups--premature infants and term neonates--in order to follow their perinatal outcome separately. In addition, maternal demographic and antenatal parameters were observed.

Results: Of 144 deliveries, the most often used mode was Bracht (78.47%), followed by Thiessen (9.03%), Muller (8.33%), MLVS (3.47%) and classical arm release (0.69%). 77.08% of pregnancies were term and 22.92% premature urgent or precipitate deliveries (22-37 gestational weeks). Apgar score >7 at 5 min was noted in Thiessen (100%), followed by Bracht (90.26%), Muller (75%), MLVS (80%) along with arterial cord blood pH value. 40 neonates were transferred to the neonatal intensive care unit. They were delivered by Thiessen (7.69%), Bracht (28.32%), Muller (33.33%), MLVS (40%) and classical arm release (100%). 60% of those transferred were premature infants and 40% term neonates transferred mostly on account of perinatal maladaptation or perinatal hypoxia. Apgar scores and arterial cord blood pH value of newborns transferred to the neonatal intensive care unit (NICU) were better when less aggressive modes of vaginal delivery were used. 92% of neonates delivered by the Thiessen mode required no other medical care; this percentage decreased in other more active modes (p < 0.001) and was 72% versus other active groups (p < 0.01) for the Bracht mode.

Conclusion: Less-traumatizing actions during vaginal delivery of breech presentation have less harmful consequences and therefore better perinatal outcome. Incidence of AS <7 and lower arterial cord blood pH value rise with the aggressiveness of the mode of vaginal delivery used.