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%).