Management trend and safety of vaginal delivery for term breech fetuses ina tertiary care hospital of Karachi, Pakistan

Aim: 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 deliv eries at or beyond 37 weeks of gestation, at the Aga Khan University Hospit al, 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 rece ived a trial of labor, 77% of which delivered vaginally. There was no neona tal or maternal death. Compared to babies delivered by emergency or electiv e cesarean section, those delivered vaginally had significantly more neonat al 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 significa nt difference in the Apgar score at 5 minutes and the risk of maternal comp lications by delivery mode. Conclusion: Allowing trial of labor to carefully selected mothers can resul t 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 assess ment and conduct of delivery by adequately trained obstetricians is perform ed.