<p style="text-align: justify;">OBJECTIVE: To compare the maternal and neonatal outcome of vaginal and cesarean breech deliveries at Bulacan Medical Centerp> <p style="text-align: justify;">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.p> <p style="text-align: justify;">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.p> <p style="text-align: justify;">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.p>
Human ; Female ; Adult ; Young Adult ; Adolescent ; Breech Presentation ; Cesarean Section ; PREGNANCY ; Pregnancy Complications ; Pregnancy Outcome

<p style="text-align: justify;">This paper presents a case of a 43 year old G4P2 (1112), diagnosed case of placenta percreta was not diagnosed despite two ultrasound procedures. A crucial table decision was made towards a conservative approach of giving methotrexate therapy upon an intraoperative finding of placenta percreta due to 50 percent risk of mortality from outright hysterectomy based on a 5 year review of our statistics and the patient's wish of preserving her uterus.The protocol for conservative management in our institution was followed: high fundal classical incision,placenta left-in-situ, uterine closure, tubal ligation. (if not desirous of another pregnancy, baseline hCG titer and laboratory exams,weekly methotrexate injection, postoperative follow up of response to treatment by serial B-hCG titers and ultrasound monitoring (20 and 3Dvolume calculation and 3D Glass Body and power Doppler assessment of vascularity).Significant decrease in B-hCGtiter was observed after 5 doses of methotrexate reaching a zero level on the 8th week post delivery. Placental volume has decreased tremendously by 50 percent on the 6th week post delivery after 4 doses of methotrexate, while complete placenta dissolution was observed on 8th month post operative delivery. No untoward side effects related to methotrexate were observed in our patient. Her regular cycle resumed four months after delivery. The successful management of placenta percreta presented in this paper further strengthens the fact that there is a room for conservative management in severe cases of abnormally adherent placenta despite previous failed attempts. Furthermore, this paper aims to emphasize on the importance of clinician's judgment call when faced with such difficult case and challenging situation.p>
Human ; Female ; Adult ; Placenta Accreta ; Methotrexate ; Sterilization, Tubal ; Conservative Treatment ; Solubility ; Hysterectomy ; Uterus ; Delivery, Obstetric ; Parturition ; Placenta