Neonatal prognosis for breech infants delivered vaginally at the Joséphine Bongo Maternity Hospital in Libreville, Gabon

Vaginal delivery of infants in the breech position always presents a risk. Objective: To assess the neonatal prognosis of vaginal breech deliveries in an urban maternity hospital in West Africa. Equipment and Method: This four-year retrospective study, from January 1996 through December 1999, examined all singleton breech deliveries at a gestational age of 32 weeks or later. Each breech delivery was compared with the two singleton births in cephalic presentation that followed. Epi Info 6.04 software was used for data analysis. Results: During the study period, the frequency of breech deliveries in our department was 2.7%, and 83 involved singleton births at or after 32 weeks. The average age of these mothers was 27.9 ± 5.7 years old ( versus 26.4 ± 5.9) and ranged from 16 to 39 years ( versus 16 to 43 years). Average parity was 3.4 ± 2.2 ( versus 3.2 ± 2.4). Mean uterine height was lower for fetuses in the breech position (30.7 ± 2.8 cm versus 31.8 ± 2.6 cm; p=0.04). The frequency of premature deliveries was 33.5% and that of low weight babies (<2,500 g) 35.4%. Both were twice that for babies delivered in the cephalic presentation (17.5% and 17.7%). Neonatal morbidity was 8 times higher for the breech deliveries, with prematurity its main cause. The rate of instantaneous neonatal mortality was 10.8% ( versus 2%), that is, 5 times greater. No clinical factors that might account for these deaths was recorded. Conclusion: Breech delivery is a risk for newborns. Development of measures and standards for obstetric practice in Gabon would help improve its prognosis.