Professional Documents
Culture Documents
Introduction
In subsequent
pregnancies(Due to lack of
tone in uterus)
In multiples pregnancies
When there is history of
premature delivery
In an abnormal shaped uterus
or a uterus with abnormal
growths, such as fibroids.
Contracted pelvis
For women with placenta
previa
Polyhydramnious/
oligohydramnious
Hydrocephaly
Relative or absculate short
cord
Types of breeches
There are four main categories of breech births:
Complete breech (10-15%) ( Hips flexed, knees flexed
(cannonball position).)
The baby's hips and knees are flexed so that the baby is
sitting crosslegged, with feet beside the bottom. The
presenting part consists of two buttocks, external
genitalia and two feet. It is commonly present in
multiparae.
Frank breech (Breech with extended legs) The breech
presents with the hips flexed and legs extended on the
abdomen (with feet near the ears). 65-70% of breech
babies are in the frank breech position. . The frank
breech presentation is the most common and the safest
position for a baby to be in if a vaginal delivery is to be
attempted.
Footling breech (35-45%) ( One or both hips
extended, foot presenting.)
One or both feet come first, with the bottom at a higher
position. This is rare at term but relatively common with
premature fetuses.
Kneeling breech - the baby is in a kneeling position,
with one or both legs extended at the hips and flexed at
the knees. This is extremely rare.
Diagnosis
During antenatal period
A few weeks prior to the due date, the health care provider
may place his/her hands on the mother's lower abdomen to
locate the baby's head, back, and buttocks. If they think the
baby is in a breech position, an ultrasound may be used to
confirm. Special x-rays can also determine the baby's
position and measure the pelvis to determine if a vaginal
delivery of a breech baby may be attempted.
On abdominal palpation
Auscultation
Breech Fetal heart best heard above Umbilicus
Diagnosis During labour
o
o
o
o
Frank breech
Per abdomen
Fundal grip
Head suggested by
Irregular small part of the feet
hard and globular mass may be felt by the side of the
head.
Head is ballotable
Lateral grip
Fetal back is to one
side and the irregular
limbs to the other
Breech suggested by
soft, broad and
irregular mass.
Pelvic grip
F.H.S.
Usually located at a
higher level round
about the umbilicus.
Management
-Cesarean Section
Frank or Complete Breech
-Attempt External Cephalic Version if:
The woman should not push until the cervix is fully dilated.
Full dilatation should be confirmed by vaginal
examination.
COMPLICATIONS
Mother
Rupture of uterus may occur during version.
Prolonged labour
Premature Rupture of Membranes
Obstructed labour due to impacted breech.
Cord prolapse may occur, particularly in the
complete, footling, or kneeling breech. This is caused
by the lowermost parts of the baby not completely
filling the space of the dilated cervix.
Traumatic post partum haemorrhage
Baby
Lower Apgar scores, especially at 1 minute, are
more common with vaginal breech deliveries.
Oxygen deprivation may occur from either cord
prolapse or prolonged compression of the cord
during birth, as in head entrapment
Injury to the brain and skull may occur due to the
rapid passage of the baby's head through the
mother's pelvis.
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Media file 5: Assisted vaginal breech
delivery. With a towel wrapped
around the fetal hips, gentle
downward and outward traction is
applied in conjunction with maternal
expulsive efforts until the scapula is
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Media file 7: Assisted vaginal breech
delivery. The anterior arm is followed
to the elbow, and the arm is swept out
of the vagina.
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2. Management
Conclusions
Vaginal breech delivery requires an experienced
obstetrician and careful counseling for the parent(s).
Although studies on the delivery of the preterm breech are
limited, the recent multicenter term breech trial found an
increased rate of perinatal mortality and serious immediate
perinatal morbidity.
Parents must be informed about potential risks and benefits
to the mother and neonate for both vaginal breech delivery
and cesarean delivery. The likelihood is high that the trend
will continue toward 100% cesarean delivery for term
breeches and that vaginal breech deliveries will no longer
be performed.
ECV is a safe alternative to vaginal breech delivery or
cesarean delivery, reducing the cesarean delivery rate for
breech by 50%. The ACOG, in its 2000 Practice Bulletin,
recommends offering ECV to all women with a breech
fetus near term. Consider adjuncts such as tocolysis,
regional anesthesia, and acoustic stimulation to improve
ECV success rates. Before performing a delivery or ECV
on a mother whose fetus is in a breech presentation, assess
for any underlying fetal abnormalities or uterine conditions
that may result in a malpresentation.