Breech presentation pdf - د. حيدر

Breech presentation

Dr Hayder Al Shamma’

objectives

• The student should be able to define breech presentation
• Able to differentiate the types
• Should be able to describe the mechanism of labour
• Should be able to list the causes
• Able to list and describe the complications
• Should be able to diagnose the condition and differentiate it

from face presentation

• Should be able to manage 1

, and 3

stages of labour

• should be able to select patients for breech vaginal delivery
• Should have an idea about ECV and know the complications

and contraindications

•Occurs when the leading part of the fetus is

the buttock (breech)

•2-3% of term pregnancy
•The denominator is the sacrum

Causes of breech presentation

1. Prematurity ( at 30 wks. 25% breech )
2. Uterine abnormalities
3. Fetal factors prevent spontaneous version
4. Placenta previa
5. fibroids
6. Hydrocephaly
7. unknown

Types of breech

I. Flexed breech (complete breech) , hips flexed ,

knees flexed.

common

in multiparous women. The presenting part is
irregular and not fit well on the cx

II. Extended breech (frank breech) , Hips flexed ,

knees extended .

common in

primigravida. Fits well on the cx

III. Footling breech , partial extension of one or both

hips ( the feet below the buttock ).

Diagnosis of breech

•On abdominal examination:-
•Long. Lie
•Head felt at the fundus as hard rounded mass

smooth and ballotable

•Lower segment feels as firm irregular non

ballotable mass

•Fetal heart heard above the umbilicus .

•On vaginal examination:-
•Signs of mal-presentation
•Feel the soft buttocks
•Soft natal cleft
•Irregular hard sacrum
•Hard ischeal tuberosities
•The anus with tuberosities form a strait line
•The feet can be felt

Differentiation from face

•Soft cheecks
•Hard chin
•Hard maxillae
•Chin and maxillae form triangle
•Mouth in the center of the triangle
•(while anus at the base of the triangle between

the tuberosities )

Differentiation between hand and foot

•The foot has a prominent heal , no heal in the

hand

•The thumb can be abducted to 90 ,while the

big toe can not

Mechanism of labor

• The largest diameter of the breech is the

bitrochanteric diameter of 10 cm

• Engagement of the bitrocanteric diameter in the

transverse or oblique diameter of the pelvis (Left

sacro-anterior or direct sacro-anterior)

• Descent in pelvic cavity followed by rotation one

buttock becomes anterior

• Further descend by lateral bend of the trunk
• Delivery of anterior buttock followed by the

posterior

Mech. Of breech ..continue

•Then engagement of the shoulders

(bisacromial diametr in transverse or oblique
diameter followed by descend of the shoulders
and rotation

•One shoulder become anterior and delivered

first

Mech. Of breech ..continue

•Engagement of the head now start to effect in

the oblique diameter of the pelvis (LOA) with
descend of the head it rotates to OA

•Rarely rotates to OP difficult labor !!!
•The head delivers by flexion

Prognosis of breech delivery

• Perinatal mortalities is X4

Hypoxia

a) delayed delivery of the head
b) cord compression
c) reduced placental flow ( uterine retraction )
d)respiratory efforts aspiration of clots or meconium

2. Intracranial hemorrhage (rapid delivery of the head ,compression

decompression of the head ) as no time for molding

Cervical spine injuries from excessive traction on the shoulder

Soft tissue injuries ( rupture spleen, liver and bowel)

Fractures of long bones

Prognosis of breech, continue….

•Maternal risks

1. Increased operative deliveries
2. Increased Genital tract injuries
3. Increased Cesarean section
4. Increased Risks of anesthesia
But the major disadvantage of vaginal breech

delivery is burdened by the fetus