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Breech presentation, types and its management

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Amala John

Gives detailed information regarding breech presentation and its different types. Also, intra-natal management of breech presentation is also included

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Breech presentation refers to the fetus in the longitudinal lie with the buttocks or lower extremity entering the pelvis first.
The lie is longitudinal with the sacrum as denominator
There are two types of breech presentation: complete,incomplete
Types of Breech Incomplete breech presentation, there is incomplete flexion with extension at 1 or 2 joint. FRANK BREECH KNEE PRESENTATION FOOTLING PRESENTATION
Types of Breech
ETIOLOGY FOR BREECH MATERNAL FACTORS Multiparity Placenta previa Cornuofundal attachment of placenta Uterine anomalies like bicornuate and septate uterus. Uterine fibroids in the lower segment Contracted pelvis Hydramnios and oligohydramnios FETAL FACTORS Prematurity Multiple pregnancy Hydrocephalus as bulky head occupies the roomy fundus Very long and short umbilical cord Extended legs
DIAGNOSIS OF BREECH PRESENTATION: Abdominal examination In case of complete breech Head on fundus region Fetal spine on one side Breech is bulky Breech is not engaged FHS above level of umbilicus
DIAGNOSIS OF BREECH PRESENTATION: Abdominal examination In case of extended breech Head is in midline of fundus region and is less ballotable due to splinting action of legs Fetal spine along with small parts on one side Breech is not bulky Breech is usually engaged FHS around level of umbilicus or lower level due to engagement.
DIAGNOSIS OF BREECH PRESENTATION: Vaginal examination Conical bag of membranes Presenting part is high up. Both ischial tuberosity, anus, sacrum, buttocks and feet are palpated-in complete breech. In extended breech,feets not palpated. In footling presentation, feets are presenting part.
DIAGNOSIS OF BREECH PRESENTATION: Ultrasonography Very useful method: Confirms the breech Type of breech To rule out any fetal anomalies and uterine anomalies. Fetal biometry, EFW Localization of placenta previa
Delivery of Buttocks Engagement : intertrochanteric diameter lies in the inlet. It can be either RSA or LSA Descent: Breech is very less efficient dilator than the head, so descent will be slow Internal rotation: More descent with lateral flexion. Birth of buttocks:- The anterior hip will come first at vulva by lateral flexion and posterior hip distends the perineum and then delivered. NORMAL LABOUR METHODS- BREECH
DELIVERY OF BUTTOCKS
NORMAL LABOUR METHODS- BREECH B Burns marshall method P Pinard maneuver L Lovset maneuver
NORMAL BREECH LABOUR METHODS The BurnsMarshall method involves allowing the breech to 'hang' by its weight until the nape of the neck (or the 'hair-line') is visible. This is followed by holding both feet and the fetus on to the maternal abdomen to deliver the fetal head.
Breech presentation, types and its management
Breech presentation, types and its management
PINARDS MANUVER
LOVSET MANUVER
Antenatal Management Antenatal management involves the following: Screening high risk factors ECV in suitable cases Decision about mode of delivery
MODE OF DELIVERY Elective caesarean delivery: All complicated breech like pre eclampsia, Contracted pelvis, placenta previa Large baby more than 3500 gm/ BPD>9.5cm Previous C.S Non availability of skilled obstetrician IUGR
MODE OF DELIVERY Vaginal delivery:

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Breech presentation, types and its management

  • 1. Breech presentation refers to the fetus in the longitudinal lie with the buttocks or lower extremity entering the pelvis first.
  • 2. The lie is longitudinal with the sacrum as denominator
  • 3. There are two types of breech presentation: complete,incomplete
  • 4. Types of Breech Incomplete breech presentation, there is incomplete flexion with extension at 1 or 2 joint. FRANK BREECH KNEE PRESENTATION FOOTLING PRESENTATION
  • 6. ETIOLOGY FOR BREECH MATERNAL FACTORS Multiparity Placenta previa Cornuofundal attachment of placenta Uterine anomalies like bicornuate and septate uterus. Uterine fibroids in the lower segment Contracted pelvis Hydramnios and oligohydramnios FETAL FACTORS Prematurity Multiple pregnancy Hydrocephalus as bulky head occupies the roomy fundus Very long and short umbilical cord Extended legs
  • 7. DIAGNOSIS OF BREECH PRESENTATION: Abdominal examination In case of complete breech Head on fundus region Fetal spine on one side Breech is bulky Breech is not engaged FHS above level of umbilicus
  • 8. DIAGNOSIS OF BREECH PRESENTATION: Abdominal examination In case of extended breech Head is in midline of fundus region and is less ballotable due to splinting action of legs Fetal spine along with small parts on one side Breech is not bulky Breech is usually engaged FHS around level of umbilicus or lower level due to engagement.
  • 9. DIAGNOSIS OF BREECH PRESENTATION: Vaginal examination Conical bag of membranes Presenting part is high up. Both ischial tuberosity, anus, sacrum, buttocks and feet are palpated-in complete breech. In extended breech,feets not palpated. In footling presentation, feets are presenting part.
  • 10. DIAGNOSIS OF BREECH PRESENTATION: Ultrasonography Very useful method: Confirms the breech Type of breech To rule out any fetal anomalies and uterine anomalies. Fetal biometry, EFW Localization of placenta previa
  • 11. Delivery of Buttocks Engagement : intertrochanteric diameter lies in the inlet. It can be either RSA or LSA Descent: Breech is very less efficient dilator than the head, so descent will be slow Internal rotation: More descent with lateral flexion. Birth of buttocks:- The anterior hip will come first at vulva by lateral flexion and posterior hip distends the perineum and then delivered. NORMAL LABOUR METHODS- BREECH
  • 13. NORMAL LABOUR METHODS- BREECH B Burns marshall method P Pinard maneuver L Lovset maneuver
  • 14. NORMAL BREECH LABOUR METHODS The BurnsMarshall method involves allowing the breech to 'hang' by its weight until the nape of the neck (or the 'hair-line') is visible. This is followed by holding both feet and the fetus on to the maternal abdomen to deliver the fetal head.
  • 19. Antenatal Management Antenatal management involves the following: Screening high risk factors ECV in suitable cases Decision about mode of delivery
  • 20. MODE OF DELIVERY Elective caesarean delivery: All complicated breech like pre eclampsia, Contracted pelvis, placenta previa Large baby more than 3500 gm/ BPD>9.5cm Previous C.S Non availability of skilled obstetrician IUGR
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