4. classifications
Frank breech (65%): where the hips are
flexed and legs extended
Complete breech (25%): where the hips and
knees are flexed and the feet are not below the
level of the fetal buttocks
Footling breech: where one or both feet are
presenting as the lowest part of the fetus
Kneeling: kneesare the lowermost presenting
part
7. Positions
the denominate is the sacrum:
First position;
left sacro-anterior (back anterior and to left).
Second position;
right sacro-anterior (back anterior and to right).
Third position;
right sacro-posterior (back posterior and to right).
Fourth position;
left sacro-posterior (back posterior and to left).
10. Fetal factors
Prematurity
Fetal anomalies (e.g neurological,
hydrocephalus, anenecephaly)
Multiple pregnancy
Fetal death
Short umbilical cord
Extended legs; because they splint the trunk,
and so interfere with spontaneous cephalic
version.
11. Mechanism of delivery
Engagement
Descent
Internal rotation
Lateral flexion
External rotation
Birth : breech then body then head
13. Clinical Diagnosis
Abdominal examination
Palpation
1. Fundal grips; the head is felt with its
characters.
2. Pelvic grip; the breech is felt, with its
characters.
Auscultation
The fetal heart sounds are head just at, or above
the level of the umbilicus.
14. Vaginal examination
1. Slow dilatation of cervix, sausage-chapel bag of fore-
waters, and liability to premature rupture of the
membrane and prolapse of the cord.
2. After rupture of the membranes, the presenting part is
felt, that is , the two buttocks with the anus in between ,
the genitalia on one side and the sacral spines on the
opposite side.
3. In case of complete breech, the feet are felt on the
same level as the buttocks.
4. In case of breech with extended legs, the buttocks only
are felt. In case of footling presentation, the feet are at
a lower level than the buttocks. In case of knee
presentation, the knees are a lower level than the
buttocks.
19. Management of breech
Management During Pregnancy:
If persisted till 34 weeks…. Then ultrasound
scan to exclude; abnormality, Ployhydramnios,
placenta praevia.
By completed 37 weeks External Cephalic
Version:
22. In delivery room
NPO and ready for c/s
CTG & USS
Tocolytic
Head down position
Dislodge breech then
gently turn around
US and CTG after procedure.
27. Management during labour
Cesarean section
Vaginal delivery
Spontaneous breech delivery
Assisted breech delivery
Total breech extraction
28. Indications of vaginal delivery
a) Frank or complete breech presentation
b) Gestational age > 36 weeks
c) Estimated foetal weight b/n 2.5-3.5 kg
d) Foetal head must be flexed
e) Adequate maternal pelvis, x-ray or ct
pelvimetry
f) No other obstetric complications.
29. Management during labour
During labour:
1. If there is contracted pelvic, and fetus is
living and good; do caesarean section.
2. First stage
Rest in bed and avoid repeated vaginal examination to
prevent premature rupture of the membranes. But
vaginal examination is done after rupture of
membranes to exclude cord prolapse.
30. Partial breech extraction or
Assisted breech delivery
Second stage :
Delivery of the aftercoming head
Burns Marshall method
Mauriceau-Smellie-veit maneuver
Prague maneuver
Piper forceps
37. Cesarean section
Indications:
Large fetus
Contraction or unfavorable shape of pelvis
Hyperextended head(Star gazing)
Uterine dysfunction
Incomplete or footling presentation
Primigravida
38. Indications of Cs in Breech
Healthy preterm
Severe fetal growth restriction
Previous perinatal death or newborn
complication of birth trauma
Lack of an experienced operator
39. Complications of Breech
Delivery
Maternal complications
Risk of Operative intervention
Risk of infection due to Manipulations
Intrauterine maneuvers : Rupture of the
uterus +/- lacerations of Cx
Extensions of the episiotomy
Uterine atony , Postpartum hemorrhage
40. Complications cont.
Fetal complications
Preterm delivery & low birth weight & IUGR
Prolapse cord
Birth aphyxia
Fetal Injuries
Fx of humerous and clavicle
Fx of femur
Hematomas of sternocleidomastoid
Separation of epiphyses of scapular,humerus or femur
Brachial plexus
Avulsion of upper C-spine
Skull Fx , intracerebral injury