Richard James Carpenter Glen Liddell Mola


Introduction The aim of this audit was to investigate the rates of breech-related perinatal death and maternal and neo-natal morbidity in a resource-poor setting where caesarean sections are difficult to perform. Method. An audit of 5,102 babies born at two rural Papua New Guinean hospitals, Kapuna and Kikori, from 2005 to 2014 inclusive was performed. Information was gathered from the facility obstetric registers and supplemented by Kikori Hospital’s surgical register. During the period there were 179 breech presentations (103 singletons, 76 twins). The primary outcome was defined as perinatal death. Secondary outcomes were neonatal morbidity and maternal post-partum haemorrhage. Exclusion criteria were applied prior to analysis. These included: Likely pre-labour intrauterine death; mother presenting to hospital in second or third stage; baby born before arrival at hospital; prematurity recorded in the notes or birth weight less than 1500g as a surrogate marker; significant fetal abnormality; and significant maternal medical condition. Findings. The adjusted incidence of the outcomes were: Perinatal death for vaginal breech singletons 235/1,000 (95% CI 158-336/1,000) and vaginal breech twins 31/1,000 (95% CI 9-107/1,000); neonatal morbidity for vaginal breech singletons 141/1,000 (95% CI 82-231/1,000) and vaginal breech twins 31/1,000 (95% CI 9-107/1,000); post-partum haemorrhage for vaginal breech singletons 129/1,000 (95% CI 74-217/1,000) and vaginal breech twins 230/1,000 (95% CI 137-361/1,000). Conclusions. Poor outcomes for singleton vaginal breech delivery at the two hospitals were common. The potential in the rural setting for increased education on safe trial of vaginal breach delivery as well as increasing access to caesarean sections deserves consideration. 


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