MECHANISM OF LABOR

IN
BREECH PRESENTATION

dr. Udin Sabarudin

Department of Obstetrics & Gynecology
Medicine School of Padjadjaran University
Bandung

THE 3 TYPES OF BREECH

PRESENTATION
Frank (65%)

: Hips are flexed, knees are

extended.
Complete (10%) : The hips and knees are
flexed
Incomplete (25%) : The feet or knees are
the lowermost presenting
part.
o Single footling : one of the lower extremities
is lowermost.
o Double footling : Both of the lower extremities
are lowermost

Figure 21-2. Breech presentations. A: Right sacrum posterior (RSP) position. B: Left sacrum
anterior (LSA) position. (Redrawn and reproduced, with permission, from Bumm E: Grundiss zum
Studium der Geburtshilfe. Bergmann, 1922)

PREDISPOSING FACTORS :

Prematurity

Uterine abnormalities : -Malformation;

-Fibroids

Fetal abnormalities

Multiple gestations

Previous breech delivery

: -CNS Malformations;
-Neck Masses

Gestational age and frequency of breech birth

Gestational age in weeks

% Breech

21-24

33

25-28

28

29-32

14

33-36

37-40

DIAGNOSIS :

Palpation and ballottement

Ultrasound

Pelvic examination

X-Ray studies

Leopold Maneuver

External Cephalic Version

MANAGEMENT DURING LABOR

Type of Delivery

Vaginal delivery:
Spontaneous

Partial

breech extraction
Total breech extraction

Cesarean of delivery

Management

Three types of vaginal breech delivery exist

Spontaneous breech (rare) : No manipulation of the

infant is necessary, other than supporting the infant.

Partial breech extraction : Fetus descend

spontaneously to where umbilicus is at the vaginal
introitus; then, the fetus is extracted completely.

Total breech extraction : The entire body is extracted.

This is indicated only if there is evidence of fetal
distress unresponsive to routine maneuvers and a
cesarean delivery is not possible.

Conditions are unfavorable for breech delivery

Fetus weight more than 3500 g

Unfavorable pelvis Breech delivery

does not
allow sufficient time for molding of the fetal head;
thus, a platypelloid or android pelvis decreases
ability fetal head to navigate maternal pelvis

Hyperextension of the head increases risk of

cervical spine injury

Footlings- incidence of umbilical cord prolapse

increases with coiling of the umbilical cord around

the legs of the fetus

MORTALITY/MORBIDITY
Increased birth trauma: As duration of

umbilical cord compression increases deliver

the infant more rapidly increasing birth
trauma
Decreased birth weight may result from
preterm delivery/growth restriction
Incidence of prolapsed umbilical cord depends
on type of breech presentation : Footling 17%,
Complete 5%, Frank 0,5%

Mechanism of Labor in Breech Delivery

Assisted Delivery of Frank Breech

Assisted Delivery of Frank Breech

Assisted Delivery of Frank Breech

Assisted Delivery of Frank Breech

Assisted Delivery of Frank Breech

Assisted Delivery of Frank Breech

Assisted Delivery of Frank Breech

Mechanism of Labor in Breech Delivery

Figure 21-5. Maneuver for delivery of the head. The fingers of the left hand
are inserted into the infants mouth of over mandible; the right hand exerts
pressure on the head from above. (Modified and reproduced, with
permission, from Benson RC:Handbook of Obstetrics & Gynecology, 8th ed.
Lange, 1983)

Mauriceau Maneuver

Delivery of the Aftercoming Head

Piper forceps

Modified prague maneuver

Mechanism of Labor in Breech Delivery

Figure 21-12. Application of Piper forceps, employing towel sling support. The forceps are
introduced from below, left blade first. Aiming directly and intended positions on sides of
the head. (Reproduced, with permission, from Benson RC:Handbook of Obstetrics &
Gynecology, 8th ed. Lange, 1983)

Forceps to Aftercoming Head

Modified Prague Maneuver

Complete or Incomplete Breech Extraction

Complete or Incomplete Breech Extraction

Complete or Incomplete Breech Extraction

Complete or Incomplete Breech Extraction

Breech Extraction

C-Section Indication

A large fetus ( > 3.500 gr )

A Hyperextended fetus

Uterine dysfunction

Footling presentation

Any degree of contraction or unfavorable

shape restriction

Previous perinatal death or children suffering

from birth trauma

COMPLICATIONS
1. Perinatal morbidity and mortality from difficult delivery

2. Low birthweight from preterm delivery, growth

restriction, or both
3. Prolapsed cord
4. Placenta previa
5. Fetal, neonatal, and infant anomalies

6. Uterine anomalies and tumors

7. Multiple fetuses
8. Operative intervention, especially cesarean delivery