title: Management trend and safety of vaginal delivery for term breech fetuses in a tertiary care hospital of Karachi, Pakistan.
abstract: OBJECTIVE
  To investigate the safety of vaginal delivery for term breech fetuses in a tertiary-care hospital of Pakistan.
  
  
  METHODS
  We reviewed the medical records of all live singleton breech deliveries at or beyond 37 weeks of gestation, at the Aga Khan University Hospital, Karachi, from January 1988 to December 1995.
  
  
  RESULTS
  Rate of cesarean section increased from 48% (1988) to 74% (1995). Out of 287 subjects, 158 underwent elective cesarean section while 129 received a trial of labor, 77% of which delivered vaginally. There was no neonatal or maternal death. Compared to babies delivered by emergency or elective cesarean section, those delivered vaginally had significantly more neonatal intensive-care unit admissions (none and 5% versus 13%) and higher rates of birth trauma (none and 0.6% versus 7%). However, there was no significant difference in the Apgar score at 5 minutes and the risk of maternal complications by delivery mode.
  
  
  CONCLUSIONS
  Allowing trial of labor to carefully selected mothers can result in vaginal delivery in 77% of the cases. However, the risk of trauma and neonatal intensive-care unit admissions, among vaginal births may favor the decision of elective cesarean section, unless rigorous pre-delivery assessment and conduct of delivery by adequately trained obstetricians is performed.
authors.affiliation: Department of Obstetrics and Gynecology, Aga Khan University, Karachi, Pakistan. medp9006@nus.edu.sg
authors.forename: N B
authors.initials: NB
authors.lastname: Mohammed
authors.forename: R
authors.initials: R
authors.lastname: NoorAli
authors.forename: C
authors.initials: C
authors.lastname: Anandakumar
authors.forename: R N
authors.initials: RN
authors.lastname: Qureshi
authors.forename: S
authors.initials: S
authors.lastname: Luby
mesh_terms: D001720:Birth Injuries / Q000453:epidemiology; D001946:Breech Presentation; D002585:Cesarean Section; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D008428:Maternal Mortality; D010154:Pakistan / Q000453:epidemiology; D011247:Pregnancy; D016896:Treatment Outcome