BREECH

PRESENTATION
 BREECH PRESENTATION
The most common malpresentation
Occurs when the fetal buttock or lower extremity
presents to the maternal pelvis
Incidence is about 3% of all deliveries
The younger the G.A , the higher the incidence of
breech presentation
AS the fetus grows, it assume the vertex
presentation to fit into the confine and shape of
the uterus
By 34weeks most fetuses would have
spontaneously changed to vertex presentation
 AETIOLOGY
Prematurity and low birth weight
Congenital anomalies that restrict the
fetus in form , function and movement-
anencephaly, hydrocephaly. Omphalocele.
Uterine abnormalities- congenital,
acquired.
Multifetal pregnancy
Placenta praevia
Hydramnios
Contracted maternal pelvis
Pelvic tumour.
 CLASSIFICATION
Frank breech- 65%. Both thighs
flexed, both knees extended
Complete breech- 10%. Both thighs
flexed. One or both knees flexed
Incomplete or footling breech
25%. One or both thigh extended,
one or both knee flexed with the
knee or feet below the level of the
buttock.
 DIAGNOSIS
Leopold examination .
Vaginal examination feel for
buttock, anus, sacrum,
scrotum,feet.
Ultrasound scan
X- ray.
 MANAGEMENT

During pregnancy
During labour
 MX DURING PREGNENCY

Achieved by performing External Cephalic Version

ECV is a transabdominal manipulation with the aim to
elevate the the breech out of the maternal pelvis while
guiding the head into the pelvis resulting in vertex
presentation
Achieved through a forward roll or a back flip
Timing- 34weeks to latent phase of labour
Requirements - ultrasound monitoring, intravenous
tocolytic, facility for emergency caesarean section.
Risk- abruptio placenta, cord compression.
Success rate 60- 75%
Contraindication- uteroplacenta insufficiency.
Hypertension, oligohydramnios, previous uterine
surgery.
 MX IN LABOUR

Vaginal delivery spontaneous

breech delivery, partial/assisted
breech delivery, total breech
extraction
Caesarean section
 PARTIAL / ASSISTED BREECH
DELIVERY
Preferred method of vaginal breech delivery
Requirements to meet- Frank or complete breech,
GA not less than 36weeks , EFW btw 2.5 to 3.8kg,
adequate pelvis , flexed after coming head, nil
maternal or fetal indication for c/s.
Zatuchni-Andros system of scoring (1965)
Likelihood of vaginal delivery. Factors considered
are- parity, GA in weeks, EFW in pound, Previous
breech delivery, cervical dilatation at admission
and station of breech at admission. Score less
than 4 predicts poor outcome . Demerit- time of
presentation in labour affects the score.
 PARTIAL / ASSISTED BREECH
DELIVERY contd.
Steps
1) Allow spontaneous delivery till the umbilicus
becomes visible.
2) Draw out loop of cord.
3) Thumb of obstetrician placed on fetal sacrum
and fingers over fetal hip.
4) Gentle downward traction until scapula
becomes visible at the introitus.
5) Lovset manoeuvre to deliver the shoulder.
6) Delivery of the aftercoming head
a)Mauriceau-Smellie Veit manoeuvre.
b) Obstetric forceps -Piper forceps.
c)Liverpool or Burn-Marshall method
 CAESAREAN SECTION
Preterm breech
Macrosomic breech
Footling breech
Primigravidae with breech
All breech for some obstetricians
(because of hazards associated with
vaginal delivery)
 HAZARDS
Increase PN morbidity and mortality
PNM-25%
Lethal congenital abnormality
Birth trauma from forceful traction ( brain, spinal
cord., liver, adrenal gland, spleen, brachial plexus,
pharynx, cleidomastoid muscle)
Birth anoxia from umbilical cord compression
secondary to cord prolapse and entrapment of
aftercoming head..
Increase maternal mortality and morbidity due to
widespread use of c/s to deliver breech.