Breech deliveries in Tygerberg Academic Hospital : maternal and neonatal outcomes of vaginal and abdominal deliveries - a case-controlled study

[摘要] ENGLISH ABSTRACT: The Objective: To review the difference in short term neonatal and maternal outcomesamong singleton infants with breech presentation delivered by vaginal or elective caesareansection route at term, at Tygerberg Academic Hospital (TBH) in Cape Town.The study design was a retrospective case control study.Method:Part IA total of 120 patients were selected. 60 vaginal breech deliveries and 60 elective caesareansections for breech presentation (comprising the control group). 60 cases of vaginaldeliveries were collected and 60 control cases of planned elective caesarean sections, wherethe indication for CS was breech presentation, were collected in the same manner.Part IINineteen registrars completed a questionnaire regarding their subjective experiences ofvaginal breech deliveries at Tygerberg Academic Hospital.Results:Part IAn analysis of the results found statistically significant differences in maternal ages betweenthe two groups, with younger women delivering by CS; gravidity and parity was lower in theCS group; blood loss was observed to be higher in the CS group with more women requiringa blood transfusion when compared to vaginal delivery; there were more neonataladmissions in the vaginal delivery group as well as more birth trauma, neonatal seizures anddeath in this group; Apgar scores were higher in the CS group and finally, neonates born byCS were more commonly discharged at the same time as their mothers in the CS group.Part IIWhen analyzing the registrar questionnaire it can be noted that although clinicians areperforming an adequate number of breech vaginal deliveries, with an average of 10deliveries per year, the skills training for clinicians is invaluable. Not all registrars learnedskills from a senior clinician and skills training in skills labs are essential for initial and evencontinual training of these clinicians. It is suggested that these skills training programs be made compulsory for all registrars and that a biyearly attendance and completing of such acourse be mandatory for those wishing to work in the labour ward.Conclusions:Although not statistically significant, there was more morbidity and mortality associatedwith vaginal breech delivery.

[发布机构] Stellenbosch University