Prognosis of breech delivery

Pranay Das

What is the prognosis of breech delivery? How does it affect fetal and maternal morbidity and mortality?

Jeffrey

@pranay-das Fetal and maternal morbidity and mortality increase with breech delivery. Fetus and infant mortality increases to 9%, compared with 3% in cephalic presentations.
A rise in the number of cesarean deliveries increases the maternal morbidity and mortality (eg, wound infection, aspiration, anesthesia risk), especially with emergency delivery.

The average Apgar score, especially at 1 minute, is lower. Congenital abnormalities increase to 6%, compared with 2.4% in infants with cephalic presentations.

Factors for increased adverse fetal outcome include the following :

Older mothers

Footling presentation

Hyperextended fetal head

Birth weight less than 2500 g or greater than 4000 g

Prolonged labor

Nonexperienced clinician

Morbidity/mortality
Various complications are associated with a breech presentation in labor. This may be due to the underlying etiology of the breech presentation, such as fetal anomalies or polyhydramnios. In addition, complications can occur as a result of umbilical cord compression due to the unusual presentation to the maternal pelvis.

The inexperienced provider when faced with a slowing fetal heart rate from cord compression is more likely to apply traction on the fetus prematurely, increasing the risk of birth trauma and nuchal arms. Nuchal arms lead to complications with delivery of the head by increasing the diameter required for delivery.

The incidence of prolapsed umbilical cord depends on the type of breech presentation, as follows:

Footling – 17% incidence

Complete – 5% incidence

Frank – 0.5% incidence

Umbilical cord abnormalities can occur. Cord length may be reduced, and, in footling breeches, there is an increased risk of the cord coiling around a leg of the fetus.

Complications
Traumatic mortality to the fetus is 12 times more likely. Intracranial fetal hemorrhage is the most common injury in breech delivery. In decreasing order of frequency, the spinal cord, liver, adrenals, and spleen also are injured.