Is there a place for selective vaginal breech delivery in Malaysian hospitals: experiences from the Ipoh hospital

Abstract

Background. The ‘Term Breech Trial’ (TBT) results of 2001 have impacted on the mode of delivery of breech with a low threshold for caesarean delivery (CD) worldwide.

Aims. The trends in mode of delivery in developing countries have also changed. The aims of this retrospective analysis of all breech presentation was to see if similar trends are seen in Ipoh Hospital in Malaysia and if perinatal outcome is affected by mode of delivery.

Methods. All breech pregnancies presenting in the labour at the Ipoh Hospital, Malaysia, irrespective of gestation or booking status were analysed with respect to mode of delivery, fetal outcome and maternal mortality.

Results. Out of 4886 breech presentation between 1992 and 2004, 3725 cases were evaluable. The prevalence of breech at birth was 3%. Vaginal breech deliveries decreased from 70.4% in 1994 to 13.1% in 2004. Consequently, CDs rose to 86.9% in CDs. There were 107 perinatal deaths (1994–2004) in the series and the crude perinatal mortality rate (PNMR) was four times higher than the hospital PNMR (11.4/1000 in 2004).

Conclusion. Although the CD rates rose exponentially with the release of the ‘TBT’, the mode of delivery did not impact on better PNMR in breech cases in this hospital. The need for selective vaginal births for breech, increased use of external cephalic version and the long implications of a uterine scar in future pregnancies in the ‘shared antenatal care in the local context in a developing country is discussed.

Keywords:

• Breech
• vaginal delivery
• caesarean delivery
• external cephalic version
• perinatal mortality