Obstetric and Perinatal Outcomes in Term Singleton Malpresentations: A Prospective Analysis

Description

Abstract (English)

Abstract
Background: Malpresentations in obstetrics refer to any fetal presentation other than vertex, including breech,
shoulder, face, brow, and compound. The management of malpresentation remains controversial, and there is a
need to evaluate obstetric outcomes in term singleton malpresentation to optimize perinatal outcomes while
preserving the art of conducting vaginal breech deliveries.
Methods: The study was a prospective observational study conducted in the Department of Obstetrics &
Gynaecology at MKCG Medical College & Hospital, Berhampur, from October 2015 to September 2017. The
study included 276 term singleton malpresentations out of 17,997 deliveries during the two-year study period,
with an incidence of 1.6%. Data on obstetric outcomes, including perinatal mortality, stillbirth, neonatal death,
and APGAR scores, were collected and analysed. The study compared outcomes between vaginal deliveries and
cesarean section deliveries, focusing on the risks of low APGAR scores and soft tissue damage in different
malpresentations.
Results: The study analyzed 276 term singleton malpresentations, with breech presentations being the most
common (81.1%). Most cases were delivered via cesarean section (69.6%), with emergency cesarean sections
accounting for 43.2%. In vaginal deliveries, breech presentations were the most common (91.6%). The perinatal
mortality rate was 11.9%, with stillbirth and neonatal death accounting for 9.4% and 2.6%, respectively. Vaginal
deliveries had a higher risk of low APGAR scores, with compelling indications being the largest factor
contributing to perinatal mortality.
Conclusion: The present study revealed that most malpresentation cases are cesarean, with breech presentations
being the most common. Vaginal deliveries in term breech malpresentations have a higher risk of low APGAR
scores, with brow and shoulder presentations having the highest rates.