Breech Presentation and Its Management2

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BREECH PRESENTATION
AND ITS MANAGEMENT.
BREECH PRESENTATION AND

ITS MANAGEMENT.
Diagnosed when cephalic pole in the uterine
fundus and caudal pole at the pelvic brim.
Commonest mal-presentation.
Incidence 25% at 28 weeks of gestation
7% at 32weeks
5% at 34 weeks and
3-4% at term
3 out of 4 spontaneous correction in to
vertex presentation by 34 weeks.
12/02/16
THREE TYPES OF BREECH

PRESENTATION
1. Frank breech-hips are flexed with
extended knees
bilaterally.
2.complete breech-both hips and
knees are
flexed.
3.footling breech-legs are extended
below
the level of the
buttocks.
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AETIOLOGY OF BREECH
PRESENTATION.
Remains obscure in significant number of
cases.
Prematurity
Factors preventing spontaneous versionabnormal placentation.
Undue mobility of the fetuspolyhydramnios.
Fetal abnormality.
Recurrent/habitual breech.
12/02/16
Diagnosis of breech
presentation.
History-fetal kick low in the
abdomen.
Physical examination-abdominal
palpation,FHB auscultation,pelvic
examination.
Ultra sound examination.
12/02/16
MANAGEMENT OF BREECH
PRESENTATION.
1-Antenatal management Identification of complicating factors
like congenital malformations of the
uterus and the fetus,placental
location,amniotic fluid volume External cephalic version.
12/02/16
EXTERNAL CEPHALIC
VERSION.
Objective:
To have vertex presentation in labour that is associated
with minimal risk to the mother and fetus
Indication:
Non cephalic presentation at or after 36 weeks of
gestation
Benefits:
Decrease incidence of breech presentation at
term,
Decrease the incidence of breech delivery and
associated complications,
Decrease the incidence of C/S delivery by about
5%.
12/02/16
TECHNIQUES AND STEPS

IN EXTERNAL CEPHALIC
VERTION.
Ultra sound examination
Should be done in labour and
delivery unit
BPP done to assess fetal well being
Tocolytic drugs to relax the uterus-terbutalin 250mg sc 20 minutes
prior.
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ACTUAL STEPS IN ECV.
STEP 1
Mobilize the breech to one illiac fossa.
Podalic pole by the right hand and head by
the left hand.
STEP 2
Pressure exerted to opposite directions to
keep the trunk well flexed.
STEP 3
The hand changed one after the other to hold
the fetal poles to prevent crossing of the hand
Check FHR after each attempt
Anti-D immunoglobulin to Rh negative non12/02/16
9
sensitized mother.
ACTUAL STEPS IN EXTERNAL

CEPHALIC VERSION
The mother to be observed for about 30
minutes.
Instructions given to the mother and follow up.
Some causes of failure in ECV
-Breech with extended legs
-Scanty liquor or big baby.
-Short cord.
-Mechanical obesity,increased tone of
abdominal muscles.
-Uterine malformations.
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COMPLICATIONS
Placental abruption.
Cord entanglement and sudden fetal
death.
PROM.
Pre-term labour.
Increased feto-maternal bleeding.
Amniotic fluid embolism.
Uterine scar dehiscence.
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CONTRA INDICATIONS FOR

ECV.
Multiple pregnancy.
Evidence of utero-placental insufficiency.
APH
Suspected IUGR,IUFD.
Amniotic fluid abnormalities.
Uterine malformations.
Maternal cardiac disease,hypertension.
Scared uterus,major fetal
anomalies,ruptured membrane,bad
obstetric history,contracted pelvis.
None- reasuring fetal heart rate pattern.
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Mode of delivery in breech

1. C/S
2. Vaginal
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VAGINAL BREECH DELIVERY.

Cases with no absolute maternal or
fetal indications for direct C/S.
EFW<3500 grms.
Frank or complete breech.
Flexed head and adequate pelvis.
Gross fetal malformations judged to
be incompatible with extra uterine
life.
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VBD
1-spontaneous vaginal breech delivery.

2-breech extraction.
alternative to emergency C/S in
desperate conditions.
some of the indications are:
fetal distress in second stage,
delivery of the second twin after
internal podalic version
cord prolapse or entanglement around
the leg
extended legs arrested at the cavity
or at the outlet.
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The preconditions are

fully dilated cervix
no mechanical obstruction,
no uterine scare,
mother should not be grand multiparous
3. Assisted Breech Delivery
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Assisted breech delivery.

Should be employed in all cases.
Patient kept in lithotomy position and
bladder emptied.
Vaginal examination to ascertain full
cervical dilatation,presence of cord
prolapse.
Do episiotomy when the fetal anus is
visible and perineum distended.
Wait with out intervention till body is born
to the level of the umbilicus.
12/02/16
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BREECH PRESENTATION AND

THREE TYPES OF BREECH

TECHNIQUES AND STEPS

ACTUAL STEPS IN ECV.

ACTUAL STEPS IN EXTERNAL

CONTRA INDICATIONS FOR

Mode of delivery in breech

VAGINAL BREECH DELIVERY.

1-spontaneous vaginal breech delivery.

The preconditions are

Assisted breech delivery.

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