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Trop Doct. 2008 Jan;38(1):36-9. doi: 10.1258/td.2007.005019.

Caesarean section as preferred mode of delivery in term breech presentations is not a realistic option in rural Zimbabwe.

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We undertook this retrospective cross-sectional study in order to establish the outcome of 510 singleton breech presentations at term in seven district hospitals in rural Matabeleland-North Province, Zimbabwe. We also studied the mortality for 1093 caesarean sections (CS), in order to decide if CS should be the preferred option for breech births. The perinatal mortality rate in singleton breech presentation (BrPNMR) was very high:166/1000. Between the hospitals the BrPNMR ranged from 66 to 225/1000 (P = 0.04). Although the outcome was better for CS than for vaginal delivery (odds ratio = 5.4, P = 0.0005), there was no correlation between the BrPNMR and the CS rate. Results indicate that closer monitoring of these high-risk pregnancies by the most senior staff would be more effective than increasing the number of CS performed. An external cephalic version at term could also reduce breech-related mortality. Symphysiotomy is a life-saving emergency intervention when the head is trapped. Increasing the number of CS should be strongly discouraged since the case fatality rate in this rural setting was found to be very high: 18/1093 women died after CS (for any indication) within 42 days after the operation (1, 6%); 15 within 24 h. Haemorrhage was the major cause of death.

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