Breech Presentation: Vaginal Delivery or Caesarean Section?

The incidence of breech presentation is approxima tely 3,97%. Breech presentation is considered as being “borderline eutocic” and it requires carefully monitoring both the foetus and the mother. The aim of the current paper is to evaluate the preffered method of delivery in case of breech presentation. The paper presents a retrospective study performed in the Obstetrics and Gynaecology Departments of the County Emergency Clinical Hospital “Sf. Apostol Andrei” in Constanta, during a period of 5 years (2010-2014). The methods of birth were analyzed for a lot of 1104 patients with breech presentation with ages ranging between 16 and 44 years old. The total number of patients who gave birth through vaginal delivery was of 139 patients, amounting to 12.59% of the total population sample. The number of patients that gave birth through C-section was 965, which amounts to 87.4% of the total population sample. Birth through C-section is preferred by both obstetricians and patients alike, due to the fact that vaginal delivery is associated with a higher foetal risk in breech presentation.


Introduction
Breech presentation is the variety of presentation in which the foetus exits the upper strait of the maternal pelvis with its inferior pole (the pelvis), its landmark point being the foetal sacrum bone.The incidence of breech presentation is approximately 3.7% [1].

Classification
Breech presentation can be: complete: with knees and hips flexed; the foetal feet can be palpated in the area of the upper opening.
incomplete: the foetal inferior members are elongated along the foetal abdomen.

Aetiology
The normal development of pregnancy is characterized by a breech presentation of the foetus in the 7 th month of gestation, after which the foetus rotates reaching a cephalic presentation.A body of mass immersed into liquid must subject itself to the laws of equilibrium, meaning that the centre of mass must be situated above the centre of gravity; from the 7 th month onwards, the centre of gravity is situated above the centre of mass, leading to the rotation of the foetus.Even though the pelvis of the foetus is larger, it is also reducible, meaning that it can better adapt to the uterine fundus, which is wider [2].

Research Methods
The current research is a retrospective study conducted in the County Emergency Clinical Hospital "Sf.Apostol Andrei" in Constanta, over a period of 5 years between the first of January 2010 and the 31 st of December 2014.Patient observation charts from 1104 patients admitted to the Obstetrics and Gynaecology Department were studied.The main point of interest was represented by the method of delivery -either through caesarean section or vaginal delivery.During the 5 years, the total number of births in the County Emergency Clinical Hospital "Sf.Apostol Andrei" was 14,763.

2010:
The total number of births was 2894, out of which 208 (7.18%) were breech presentation births.Out of these, 173 patients delivered through C-section (83.7%) and 35 through vaginal delivery (16.83%)

:
The total number of births was 2793, out of which 234 (8.37%) were breech presentation births.Out of these, 205 patients delivered through C-section (87.6%) and 29 through vaginal delivery (12.4%).
Total study lot, fig.1:Throughout the 5 years of study, the total number of births was 14,763, out of which a total of 1,104 were breech presentation births (7.47%).Out of these, a total of 965 were C-sections (87.4%), while the remainder of 139 were vaginal deliveries (12.59%).

Ages of patients who delivered vaginally:
Patients younger than 20-years old: 12 (8.63%);Patients between 20-30 years old: 71 (51.07%);Patients between 31-40 years old: 46 (33,09%); It can be observed that the maximum incidence is over 50% for the 20-30 years old age group, both for patients who delivered vaginally and for those who delivered through C-section.
Birth in breech presentation can follow the natural course of vaginal delivery in optimal conditions.Birth can either occur spontaneously (Vermelin [1) or through manual assistance (Bracht-Tovianov [1]).Others recommend a systematic Csection (Wright) [2].
The Romanian Obstetrics-Gynaecology Guidelines recommend a C-section in the following situations: -Primitive extension of the foetal skull; -Foetal macrosomia (estimated foetal weight over 3,800g); -Prolapse of the umbilical cord; cord or nuchal cord 3. Foetal factors: -Large foetuses (larger than 3800 g) -Foetal malformation characterized by abnormalities of the cephalo-pelvic disproportions: hydrocephalus, anencephaly, cerebral meningocele -Multiple pregnancies