DR. RAZAQ O. MASHA, FRCOG

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BREECH ABNORMAL PRESENTATIONS

• DR. RAZAQ O. MASHA, FRCOG
• Consultant, Ob/Gyn Dept.

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• Breech presentation occurs in 3-4 of all
  deliveries. The percentage of breech deliveries
  decreases with advancing gestational age from 25
  of births prior to 28 weeks gestation to 7 of
  births at 32 weeks gestation to 1-3 of births at
  term

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• PREDISPOSING FACTORS
• ? Prematurity
• ? Uterine malformations or fibroids
• ? Placenta praevia
• ? Fetal abnormalities, (e.g. CNS
• malformations, neck masses)
• ? Multiple gestations
• Fetal abnormalities are observed in 17 of
  preterm breech deliveries and 9 of term breech
  deliveries. Perinatal Mortality is increased 2-4
  fold with breech presentation, regardless of the
  mode of delivery.
• Deaths are most often associated with
  malformations, prematurity and intrauterine fetal
  demise.

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• TYPES OF BREECHES
• ? Frank breech (50-70) Hips flexed, knees
  extended
• ? Complete breech (5-10) Hips flexed, knees
  flexed
• ? Footling or incomplete (10-30) One or both
  hips extended, foot presenting

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• EXTERNAL CEPHALIC VERSION (ECV)
• This is the trans-abdominal manual rotation of
  the fetus into a cephalic presentation.
• ? Improved outcome may be related to the use
  of non stress tests both before and after ECV
• ? Improved selection of low-risk fetuses
• ? Rh immune globulin to prevent isoimmunization

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• PROCEDURE
• ? Prepare for the possibility of caesarean
  delivery.
• ? Perform a non-stress test to confirm fetal
  well being.
• ? Perform the ECV, in or near a delivery suite
• ? After ECV, repeat the non-stress test.
• ? Administer Rh immune globulin to women who
  are Rh- negative

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• RISKS
• ? Precipitation of labour or premature rupture
  of membranes
• ? Abruptio placentae
• ? Feto-maternal haemorrhage
• ? Cord entanglement
• ? Fractured fetal bones

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• CONTRAINDICATIONS
• ? Multiple gestations
• ? Contra indications to vaginal delivery (e.g.
  herpes simplex virus infection, placenta
  praevia)
• ? Non reassuring fetal heart rate tracing

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• VAGINAL BREECH DELIVERY
• The three types of vaginal breech deliveries are
  described
• ? Spontaneous breech delivery. No traction or
  manipulation of the infant is used. This occurs
  predominantly in very preterm deliveries.
• ? Assisted breech delivery The most common
  type of vaginal breech delivery.
• ? Total breech extraction. Use for a non
  cephalic second twin and caesarean deliveries

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• RISKS
• ? Lower apgar scores
• ? Fetal head entrapment
• ? Cervical spine injury
• ? Cord prolapse