breech presentations

1
BREECH PRESENTATIONS

• By Dr. Makanda
• OBGY Dept
• HKMU 2023

2
BREECH PRESENTATIONS

• Fetus in longitudinal lie and podalic pole
  presents at the pelvic brim
• Incidence is about 20 at 28 weeks and drops to
  5 at 34 weeks and
• 3-4 at term
• Types 1. Complete- Normal attitude of full
  flexion
• 2. Frank Breech- Thighs flexed on the trunk
  and legs extended
• 3. Footling- thighs and legs partially extended
  bringing the legs to present at the pelvic
  brim

3
Breech Presentations
4
Aetiology

• Small sized fetus and comparatively large amount
  of amniotic fluid allows the fetus to undergo
  spontaneous version by fetal kicks
• Factors responsible-
• - Prematurity
• - Factors preventing spontaneous version
  (Twins, Oligohydramnious Congenital malformation
  of the uterus),

5
Breech POSITIONS
6
(No Transcript)
7
Criteria for Vaginal Delivery vs Caesarean Section

• Vaginal Delivery
• Frank
• GA gt34 wks
• FWt gt1500-3500gm
• Adequate pelvis
• Flexed head
• Nonviable fetus
• Good progress labor

• Caesarean Section
• FWtlt1500 or gt 3500gm
• Footling
• Small pelvis
• Deflexed head
• Arrest of labor
• GA24-34w
• Elderly PG
• Infection or poor history
• Fetal distress

8
VAGINAL BREECH DELIVERY

• Three types of vaginal breech deliveries
• 1. Spontaneous breech delivery
• 2. Assisted breech delivery
• 3. Total breech extraction

9
Assisted Breech delivery

• Assisted vaginal breech delivery No downward or
  outward traction is applied to the fetus until
  the umbilicus has been reached.

10
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 reached. An assistant should
  be applying gentle fundal pressure to keep the
  fetal head flexed

11
Delivery

• The fetus is rotated 180, and the contralateral
  arm is delivered in a similar manner as the
  first. The infant is then rotated 90 to the
  back-up position in preparation for delivery of
  the head.

12
Delivery.

• The fetal head is maintained in a flexed position
  by using the Mauriceau-Smellie-Veit maneuver,
  which is performed by placing the index and
  middle fingers over the maxillary prominence on
  either side of the nose. The fetal body is
  supported in a neutral position with care to not
  overextend the neck.

13
Picture 12. Assisted vaginal breech delivery - The neonate after birth Picture 12. Assisted vaginal breech delivery - The neonate after birth
                              
14

• Low 1-minute Apgar scores are not uncommon after
  a vaginal breech delivery. A pediatrician should
  be present for the delivery in the event that
  neonatal resuscitation is needed

15
External Cephalic Version
16
Risks of breech delivery

• Lower Apgar scores
• An entrapped head
• Nuchal arms
• Cervical spine injury
• Cord prolapse

,
17
Thank you for your Attention!

• !!