Delivery Techniques at Elective Caesarean Section for the Singleton Term Transverse- Lying Fetus in a Nigerian Teaching Hospital

Differing recommendations regarding the optimum delivery techniques for term singleton transverse-lying fetuses at elective caesarean section led to this study to document the University of Calabar Teaching Hospital’s experience for the first time. This cross-sectional retrospective study aimed to establish the intra-operative delivery techniques applied and the immediate outcome. Techniques at delivery and immediate maternal and fetal complications were extracted from theater/labor ward registers and case notes of women who met the criteria over 5 years. About 31% of the women had a previous uterine scar. Low-isthmic transverse uterine incisions, low uterine body transverse incisions, upper vertical incisions and low vertical incision were applied in 91.6%, 5.6%, 2.8% and 0% of the patients respectively. Intra-uterine version was applied in all cases. Delivery was as breech in 83% and cephalic in 16.7% of the women. About 33% of fetuses delivered cephalic were by forceps. Maternal complications were lateral tears of low isthmic incisions, conversion to inverted T incisions, blood loss >1000mls and blood transfusion in 5.6%, 5.6 %, 11.1% and 2.8% respectively. Conversions to inverted T incisions were in women with poorly formed lower segments. 5-minute Apgar score <7 and death occurred in an infant with multiple Transnational Journal of Science and Technology May 2013 edition vol.3, No.5 ISSN 1857-8047 33 anomalies. Conclusions Delivery through low isthmic transverse incisions following intrauterine version to breech presentation is preferred in the hospital. It is successful regardless of fetal back position but may not be the best option if the lower segment is poorly formed. Maternal and fetal outcome are good.