Results
During the period from June 2018 to December 2019, we had 92 cases of
breech deliveries at our department after the exclusion of medical
indications for cesarean delivery in case of breech delivery. These
include:preeclampsia, placenta previa, placenta abruption, fetal
distress and the scheduled cesarean in the absence of labor.
No induction of labor was performed.
In group R6 the prevalence of assisted vaginal delivery (VD) is
significantly higher (7/17=41.1%) in the group of simulation and no
assisted vaginal delivery (0/20) was attempted in the group of
obstetricians who did not attend the simulation (Table 1).
The difference is significant (p<0.05), and the simulation has
an effect in the category R6 where the obstetrician who attended the
simulation session would try more frequently than the obstetrician who
did not attend the simulation session to deliver the patient by assisted
vaginal delivery. A senior physician (attending physician or senior
resident) was present in these cases.
On the other hand, in group R7 the prevalence of assisted VD is
comparable between both groups (6/29=20.7% in the group of simulation
and 7/26=27% in the group of obstetricians who did not attend the
simulation (p>0.05).
The rate of Cesarean delivery was significantly reduced in the groups R6
and R7 between July and December 2019, immediately after the end of
simulation sessions and then it increases between January and June 2020,
reaching comparable rates as before the training sessions (Figure 1).
Neonatal outcomes
The admission to the neonatal intensive care unit (NICU)
The reasons for admission to the NICU is mainly due to prematurity in
vaginal delivery and cesarean groups.
The prevalence of admission to the NICU in the assisted vaginal delivery
group was 20% (4/20) and the reason for admission was mainly
prematurity because all the newborn admitted were delivered between 28
weeks and 33 weeks of gestation. All the term babies delivered vaginally
did not need admission to the NICU.
The prevalence of admission to the NICU in the cesarean group was 14%
(10/72) 3 of these were delivered at full term (39 weeks,38 weeks and
38weeks+2d) The reasons for admission to the NICU were intrauterine
growth restriction (IUGR) in one case and respiratory distress in the 2
others and the other 7 cases were admitted to the NICU for prematurity.
One of these was delivered at 29 weeks+2d, intubated then died.
Apgar score
8 of the 9 cases of term pregnancies who delivered vaginally had an
Apgar score of 9/10 at 1 and 5 minutes of birth. The 9th case died at
birth because of IUGR and multiple malformations. The evaluation of the
Apgar score in the preterm group could be biased by the effect of
prematurity.
A low Apgar score associated with admission to the NICU (due to IUGR and
fetal distress) was found in term cesarean deliveries in 2 cases out of
57 (3.5%).