Retrospective study concearning the risk factors, causes, type of birth indications and comparative analysis of complications in case of breech presentation of single fetus at term

Abstract

Introduction: For 3-4% of pregnancies, the fetus will be in breech presentation at term. For most of these women, the approach to delivery is controversial. Purpose and objectives: • Identifying the causes that may lead to a higher rate of pregnancies with breech babies at term; • Highlighting the most frequent complications during pregnancy with breech presented babies; • Comparing natural delivery with caesarian birth and concluding witch way is safer for these particular cases. Materials and methods: The study is based on 46 pregnant women out of 1777, which is the total number of births for 2013 at the PI Municipal Maternity Nb.2. We did a retrospective trial, based on their clinical observation sheets, in order to determine which are the most common causes that may lead to this form of presentation and what the evolution of the pregnancy was. Also, we compared the policy of planned caesarean section with a policy of planned vaginal delivery and the complications occurred during and 5 days after birth for selected breech-presentation pregnancies. ResuIts: Data was received for 46 women out of a total of 1777 women, which represents 2.6%. 84.78% women assigned caesarian section, among which 15.38% were planned (66.67% - primiparous and 33.33% multiparous) and 84.62% were emergencies (63.63% - primiparous, 36.37% - multiparous). 15.22% assigned planned vaginal birth (42.86% - primiparous, 57.14% - multiparous). Out of the total number of breech births cases, 60.87% were primiparous, and 39.13% were multiparous.The identified complications during and after natural birth were: dynamic dystocia (hypokinetic and hypotonic) - 14.29% and hemorrhage - 14.29%; during and after caesarian delivery there has been one case with complication (hemorrhage) -2.56%. Out of the most common causes described in literature, the following causes have been revealed in our study: bicornate uterus - 2.17%, oligoamnios- 4.35%, hidramnios - 2.17%, fetal-placental insufficiency - 4.35%, macrosome fetus - 6.52%.The relative risk - the risk to develop complications during natural birth is 28,5 times higher than that for caesarian section. Conclusion: • The most common conditions that led to breech presentation at term are: bicornate uterus, oligoamnios, hidramnios, fetal-placental insufficiency and macrosomy; • The most frequent complications during delivery are dynamic dystocia and hemorrhage, both in case of vaginal delivery; • These results led us to the conclusion that planned caesarean section is safer than planned vaginal birth for fetus at term in breech presentation; There were no differences between groups in terms of maternal mortality or serious maternal morbidity;