Second Delivery in Women with a Previous Elective Caesarean Section for Breech Presentation in first Pregnancy

Abstract

Abstract:Objective: To evaluate the mode of next delivery and fetal presentation for women who had an elective caesarean section for breech presentation when primigravidae. Design: Retrospective- follow up cohort study.Setting: Al- Yarmouk Teaching Hospital/department of Obstetrics and Gynaecology.Methods: 333 women who presented for delivery of their second baby at > 34 weeks of gestation during the period Jan 2002-Jan 2004 with a history of an elective caesarean section when primigravidae: 189 of them for a breech presentation and 144 for other indications with a cephalic presentation, were studied to evaluate the fetal presentation and the mode of their second delivery. Results: Of 189 women who had an elective caesarean section with a breech presentation when primigravidae , 16 (8.5%) had a breech presentation at the time of elective caesarean section for their next baby compared with only 3 (2.1%) in women who had an elective caesarean section with a cephalic presentation when primigravidae ( RR 4.06 [ 95% CI 1.2 to 13.67 ] ) . The overall repeat section rate was 41.3% (n = 78) in women with a previous breech presentation (n = 189), compared with 59% (n = 85) in women with a previous cephalic presentation (n = 144) (RR 0.70 [95% CI 0.56 to o.86]). The vaginal birth rate for those women allowed to labour was 80.4% (n=111) if the presentation previously was breech (n = 138) compared with 64.8% (n = 59) if the presentation previously was cephalic (n=91) (RR 1.24 [95% CI 1.04 to 1.47]). Conclusions: Women who had an elective caesarean section for a breech presentation when primigravidae were shown to have 8.5% chance of having an elective caesarean section for a breech presentation in their second pregnancy. The incidence of repeat caesarean section for their second baby was 41.3%, and of those allowed to labour, 80.4% achieved a vaginal delivery compared with 59% and 64.8% respectively for women who had an elective caesarean section with a cephalic presentation in their first pregnancy. These results will help in counseling primigravida women with a breech presentation intended to be delivered by an elective caesarean section," aiming at reduction of perinatal morbidity and mortality", about the good chances of a successful vaginal birth of their second baby with a cephalic presentation and also provides more information about mode of delivery in the presence of previous one caesarean section. Key words: previous caesarean section, breech, second delivery