OBJECTIVE: To compare the maternal and neonatal outcome of vaginal and cesarean breech deliveries at Bulacan Medical Center

MATERIALS AND METHODS: A two-year retrospective descriptive study on all patients who delivered breech by vaginal or cesarean section from January 1, 2012 to December 31, 2013. The maternal and neonatal outcomes were compared and analyzed.

RESULTS: There were 165 deliveries included during the study period. There were 83 cases of vaginal breech delivery and 82 cases of cesarean breech delivery. The incidence and risk of postpartum hemorrhage is higher among cesarean breech delivery (7%). Febrile morbidity (p=0.0223) is significantly lower for vaginal breech births. Cesarean breech delivery is correlated with longer hospital stay (p=<0.0001). There were no significant differences on the incidence of asphyxia (5% vs 2%, RR=0.51, RD=-2%, p=0.4141), birth trauma (2% vs 1%, RR=0.51, RD=1%, p=0.5673) and sepsis (12% vs 9%, RR=0.71, RD=-4%, p=0.4582) for vaginal or cesarean breech delivery. Prolonged hospital stay is 2.10 times more likely to occur for cesarean breech deliveries compared with vaginal breech deliveries. Thus, shorter hospital stay means lesser hospital costs for both mother and babies.

CONCLUSION: There is no significant difference in maternal and perinatal morbidity and mortality between vaginal and cesarean breech delivery except for longer hospital stay and increased febrile morbidity for cesarean births. It is therefore safe to recommend vaginal breech delivery under hospital-specific guidelines for labor management such as strict selection of patients, high quality fetal monitoring and high level of competence among obstetricians to deliver breech.

Human ; Female ; Adult ; Young Adult ; Adolescent ; Breech Presentation ; Cesarean Section ; PREGNANCY ; Pregnancy Complications ; Pregnancy Outcome

BACKGROUND: Conservative treatment of ectopic pregnancy using methotrexate for medical management has been considered an alternative to surgical intervention.

OBJECTIVE: To present and discuss cases of ectopic pregnancies seen in our institution from 2007 to 2010 successfully treated using single dose methotrexate.

METHODS: All patients diagnosed with ectopic pregnancy seen in our institution from 2007 to 2010 who met our selection criteria for medical treatment were included in the study. Cases were included only when the diagnosis was made either on serial βhCG or with ultrasonographic features of an unruptured ectopic pregnancy: 1)an empty uterine cavity, 2) adnexal mass

RESULTS: All of the nine cases of unruptured ectopic pregnancies treated using 50mg single dose intramuscular methotrexate were successfully resolved without need for surgical intervention. There was a significant reduction in serum βhCG after the single dose of treatment with minimal side effects. Complete βhCG resolution was achieved (100% success rate) in all medically treated cases with a minimum of 4 days and a maximum of 35 days of serial βhCG monitoring.

CONCLUSION: Conservative management using single dose methotrexate is a safe and effective option to surgical intervention in the treatment of unruptured ectopic pregnancies. However,it is reserved for patients that satisfy the strict criteria for medical treatment. This mode of treatment offers minimal side-effects, has the advantage of avoiding invasive surgery and a cost effective method of treatment.

Human ; Female ; Pregnancy ; Methotrexate ; Conservative Treatment ; Patient Selection ; Pregnancy, Ectopic ; Fetal Movement ; Patient Compliance ; Liver

BACKGROUND: Conservative treatment of ectopic pregnancy medically managed using methotrexate has been considered an alternative to surgical intervention.

OBJECTIVE: To present and discuss cases of ectopic pregnancies seen at the Bulacan Medical Center from 2007 to 2010 successfully treated using single dose methotrexate.

METHODS: All patients diagnosed with ectopic pregnancy seen at the Bulacan Medical Center from 2007 to 2010 who met our selection criteria for medical treatment were included in the study. Cases were included only when the diagnoses were made either on serial βhCG or on ultrasonographic features of an unruptured ectopic pregnancy: 1) an empty uterine cavity, 2) adnexal mass

RESULTS: All of the nine cases of unruptured ectopic pregnancies treated using 50mg single dose intramuscular methotrexate were successfully resolved without need for surgical intervention. There was a significant reduction in serum βhCG after the single dose of treatment with minimal side effects. Complete βhCG resolution was achieved (100% success rate) in all medically-treated cases with a minimum of 4 days and a maximum of 35 days of serial βhCG monitoring.

CONCLUSION: Conservative management using single dose methotrexate is a safe and effective option to surgical intervention in the treatment of unruptured ectopic pregnancies. However, it is reserved for patients that satisfy the strict criteria for medical treatment. This mode of treatment offers minimal side-effects, has the advantage of avoiding invasive surgery and a cost effective method of treatment.

Human ; Female ; Methotrexate ; ; Conservative Treatment ; ; Patient Selection ; ; Pregnancy, Ectopic ; ; Treatment Outcome ; ; Fetal Movement ; ; Liver