Medico-legal Issues in a Breech Delivery

Abstract

Introduction A breech delivery is the birth of a baby from a breech presentation, in which the baby exits with the buttocks or feet first as opposed to the normal head-first presentation. When planned vaginal delivery is compared with planned cesarean delivery, the evidence unequivocally shows the relatively greater safety of planned cesarean delivery for breech presentation at term gestation. Case report A 34 year old P4C2 full term mother, who had normal past vaginal deliveries, had gestational OM in her second trimester, and was found to having breech presentation well ahead of the EDD. She started dribbling at home and she was admitted to a District Hospital and was transferred to a Base Hospital for specialized management. Normal vaginal delivery was attempted and failed. Therefore, forceps delivery was done. A baby girl was born but the condition deteriorated rapidly. She was pale and floppy and was admitted to the Neonatal Unit. Despite resuscitation efforts the baby died 1 ½ hours after birth. PM examination was delayed 4 days due to non-availability of the order of the ISD. Autopsy revealed a contusion under the scalp, a subdural haemorrhage (SDH) at the base and a diffuse subarachnoid haemorrhage (SAH). COD was SDH and SAH due to assisted breech delivery. But the mother expressed her dissatisfaction about the medical management during labour. Conclusions There are medico-legal impacts of delaying a PM examination due to- procedures of the inquirer. If breech delivery is done vaginally, it should be planned properly. Otherwise, a planned LSCS should have been arranged.