INFLUENCE OF THE LEGS IN BREECH PRESENTAT ION AND ITS AFFECT ON THE MODE OF DELIVERY AND EARLY NEONATAL MORBIDITY

The objective of the present study is to establish whether the positio n of the legs in breech presentation deliveries affects the vaginal or abdominal mode of surgical delivery and the early neonatal morbidity. The patient population investigated (n = 266) comprised 163 primipara e (61.3%) and 103 multiparae (38.7%). Of the 266 term infants (more th an 37 complete WOP) with breech presentation? 71.3% (127/178) could be delivered vaginally from a simple pelvic presentation and 55.3% (42/7 6) from an incomplete or complete footling presentation. The average d uration of labor was 460 minutes in a pelvic presentation delivery, an d 400 minutes in a footing presentation delivery. The rate of acidosis (pH(NA) <7,20) was 26% in the neonates delivered from the pelvic pres entation as compared to 11,9% in the footling presentation deliveries. The number of neonates with a 5/10 minute APGAR score of seven points was 0/0% in pelvic and 4.8/2.4% in footling presentation. Of the neon ates delivered from pelvic presentation, 10.2% (13/127) were moved to the neonatology department as compared to 14.3% (6/42) babies delivere d from footling presentation. A secondary Cesarean section was indicat ed in 28.7% of pelvic presentation deliveries commenced vaginally (51/ 178) and in 44.7% of the footling deliveries (34/76). The rate of acid osis was 49% (25/51) in the babies with pelvic presentation and 21% (7 /34) in the babies with footling presentation. The percentage of neona tes with respiratory depression (5/10 minute APGAR score <7 points) wa s 3.9/2.9% in the babies delivered from pelvic presentation and 2/0% i n the babies delivered from footling presentation. Correspondingly, th e rate of transfer to the neonatology ward was extremely high: 33.3% ( 17/51) of the pelvic presentation babies and 8.8% (3/34) of footling b abies. In 11 pregnant women (5.8%) with a fetus in pelvic presentation , a primary Cesarean section was indicated, in half of these cases (n = 5) because of ''suspicion of a discrepancy'', three times at request of the patients and three based on fetal and on maternal indication. Because she had rejected vaginal delivery, primary Cesarean section wa s performed in one pregnant mother (1.3%) with a fetus in footling pre sentation. Fetuses with simple pelvic presentation at term were more f requently delivered vaginally than fetuses in footling presentation (7 1.3% compared to 55.3%). The rate of respiratory acidosis was higher i n the neonates with pelvic presentation than those with footling prese ntation (26% as compared to 11.9%). They compensated this acidotic met abolism within a short time, so that the transfer to the neonatology w ard was only temporary. The same applied to the babies delivered by se condary Cesarean section.