FETO MATERNAL OUTCOMES OF SINGLETON BREECH DELIVERIES AT MOI TEACHING AND REFERRAL HOSPITAL, ELDORET, KENYA

ABSTRACT Background Breech presentation which occurs in approximately 3% to 4% of all women at term, is a major concern for both pregnant mothers and their reproductive healthcare providers. This is because it is associated with increased adverse maternal and perinatal outcomes. Objective To describe the fetal and maternal outcomes of singleton breech deliveries at Moi Teaching and Referral Hospital (MTRH). Methods This was a cross-sectional descriptive study. The study participants were women with singleton breech deliveries at a gestation of 28 weeks or more. Hospital records indicated that very few breech deliveries occurred at the facility per year. Therefore, a census of all the eligible women with singleton breech deliveries was taken. A semi-structured interviewer-administered questionnaire was used for data collection. Results There was a total of 11, 748 singleton deliveries at MTRH during the study period (30th August 2019 to 27th August 2020), of which 125 (1.06%) were singleton breech deliveries. Of these, 75 met the eligibility criteria to participate in the study whereby 65 (86.7%) gave birth through emergency caesarean section while 10 (13.3%) had emergency vaginal breech delivery. Most women (50.67%; n=38) delivered at a gestational age of between 38 - 40 weeks and 72 (96%) of the women enrolled had live births. Most (66.70%) newborns weighed 2500 – 3499grammes with 70 (93.3%) newborns having a 5-minute APGAR score of≥7. The majority (85.3%) of the newborns did not have birth complications however, 5 (6.7%) were admitted to the newborn unit due to birth asphyxia while 1 (1.3%) had delayed aftercoming head. The maternal complications noted were second- and third-degree perineal tears (5.3%), post-partum haemorrhage (4.0%) and anaesthetic complications (1.3%). Conclusion This study noted that despite the MTRH breech delivery protocol recommendation for caesarean section for breech presentation, 13.3% of the women had vaginal breech deliveries. Birth complications (birth asphyxia, NBU admission and delayed aftercoming head) occurred in about 15% of the newborns regardless of the mode of delivery. Furthermore, 40% of these women sustained second- and third-degree perineal tears.