THE RELATIONSHIP BETWEEN MODE OF DELIVERY AND DEVELOPMENTAL DYSPLASIA OF THE HIP IN INFANTS BORN BREECH

Abstract

Purpose of study: Recent literature suggests the mode of delivery; either normal vaginal delivery (NVD) or caesarean section (LSCS) influences the incidence of DDH for term breech infants. This study examines whether the incidence of DDH amongst term breech infants is related to the mode of delivery.

Methods: All term infants born breech between 1^st April 1995 and 31^st March 2002 were included. All infants who presented breech were screened by ultrasound as part of an ongoing longitudinal cohort study. Data regarding mode of delivery, either NVD or LSCS elective or LSCS emergency was obtained from hospital records. DDH is a spectrum from minor dysplasia to dislocated irreducible hips. DDH was recorded according to the modified Graf classification.

Results: During the 7-year period 25,919 infants were born in the study population. 996 infants presented as breech, fulfilling the inclusion criteria. 164 (16.5%) were normal vaginal deliveries. 167 (16.8%) had emergency caesarean section. 664 (66.7%) had elective caesarean section.

In total 48 patients were diagnosed with DDH. 10 patients had bilateral DDH giving a total of 58 dysplastic hips.

Conclusions: Infants delivered by normal vaginal delivery or emergency caesarean section had a significantly higher incidence of DDH than those delivered by elective caesarean section. This study suggests that the mode of delivery does influence the stability of hips in infants lying breech at term.