Breech delivery at a University Hospital in Tanzania.
There is a global increase in rates of Cesarean delivery (CD). A minor factor in this increase is a shift towards CD for breech presentation. The aim of this study was to analyze breech births by mode of delivery and investigate short-term fetal and maternal outcomes in a low-income setting.



The study design was cross-sectional and the setting was Muhimbili National Hospital (MNH), Dar-es-Salaam, Tanzania. Subjects were drawn from a clinical database (1999-2010) using the following inclusion criteria: breech presentation, birth weight ≥ 2,500 g, single pregnancy, fetal heart sound at admission, and absence of pregnancy-related complication as indication for CD. Of 2,765 mothers who had a breech delivery, 1,655 met the inclusion criteria. Analyses were stratified by mode of delivery, taking into account also other birth characteristics. The outcome measures were perinatal death (stillbirths + in-hospital neonatal deaths) and moderate asphyxia. Maternal outcomes, such as death, hemorrhage, and length of hospital stay, were also described.



The CD rate for breech presentation increased from 28 % in 1999 to 78 % in 2010. Perinatal deaths were associated with vaginal delivery (VD) (adjusted odds ratio (aOR) 6.2; 95 % confidence interval (CI) 3.0-12.6) and referral (aOR 2.1; 95 % CI 1.1-3.9), but not with parity, birth weight, or delivery year. Overall perinatal mortality was 5.8 % and this did not decline, due to an increase in stillbirths among vaginal breech deliveries. Mothers with CD had more hemorrhage compared to those with VD. One mother died in association with CD, and one died in association with VD.



A breech VD, compared to a breech CD, in this setting was associated with adverse perinatal outcome. However, despite a significant increase in CD rate, no overall improvement was observed due to an increase in stillbirths among VDs.
Department of Women's and Children's Health, Uppsala University, SE-751 85, Uppsala, Sweden. ulf.hogberg@kbh.uu.se.
Ulf
U
Högberg
Department of Obstetrics and Gynecology, Karolinska University Hospital, 171 76, Solna, Sweden.
Catrin
C
Claeson
Department of Obstetrics and Gynecology, University of Copenhagen, and Holbæk Hospital, Copenhagen, Denmark.
Lone
L
Krebs
Department of Women's and Children's Health, Uppsala University, SE-751 85, Uppsala, Sweden.
Agneta Skoog
AS
Svanberg
Department of Women's and Children's Health, Uppsala University, SE-751 85, Uppsala, Sweden.|Department of Obstetrics and Gynecology, Muhimbili National Hospital, Dar-es-Salaam, Tanzania.
Hussein
H
Kidanto
D001034:Apgar Score; D001724:Birth Weight; D001946:Breech Presentation / Q000601:surgery*; D002585:Cesarean Section / Q000009:adverse effects / Q000706:statistics & numerical data / Q000639:trends; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D017052:Hospital Mortality; D006785:Hospitals, University / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D007231:Infant, Newborn; D007902:Length of Stay; D063130:Maternal Death; D010298:Parity; D054238:Perinatal Mortality; D011247:Pregnancy; D050497:Stillbirth / Q000453:epidemiology*; D013636:Tanzania / Q000453:epidemiology; D014592:Uterine Hemorrhage / Q000209:etiology
Asphyxia neonatorum; Breech presentation; Caesarean section; Developing countries; Hemorrhage; Perinatal mortality