3) Breech Presentation; Breech Delivery - Diagnosis, Management, Mechanism of Labor

Question 1

What is the definition of “Breech Presentation”?

Answer 1

• Presentation where Foetus lies longitudinally
• With the butt + feet close to CERVIX

Question 2

What are the Causes of Breech Presentation?

Answer 2

MATERNAL Factors

• Poly / Oligohydraminos
• Uterine / Placental Abnormalities
• Fibroids
• Small Pelvis
• Multiparity

FOETAL Factors

• Prematurity
• Foetal Abnormalities
• Foetal Death
• Multiple Pregnancy
• Short Umbilical Cord

Question 3

What are the 3 Types of Breech?

Answer 3

1) Complete = Hips + Knees Flexed

2) Frank Breech = Legs flexed at HIP, with knee extension

3) Footling (Incomplete) = Either 1 leg flexed + other extended; or BOTH hips / legs EXTENDED

Question 4

What are the Positions in Breech Presentation?

Answer 4

• Left + Right sacro-anterior
• Right + Left sacro-posterior
• Left + Right sacro-transverse
• DIRECT sacro-anterior + Posterior

Question 5

How’s Breech Presentation diagnosed?

Answer 5

1) Leopold’s Maneuver

• (1st) Head occupying fundus of uterus
• (3rd / 4th) Breech occupying lower pole of uterus

2) Vaginal Exam = Assessing Types of Breech

3) Ultrasound

Question 6

What’s the Indication for a C-Section?

Answer 6

• A large foetus = MORE than 3.5Kg
• Hyper-extended
• Uterine Dysfunction
• FOOTLING Breech Presentation
• Previous Perinatal Death

Question 7

What’s the Indication for a Vaginal Delivery?

Answer 7

• FRANK or COMPLETE Breech Presentation
• Gestational Age of MORE than 36 GW
• Estimated Weight of 2.5 - 3.5 Kg
• Flexed Foetal Head
• Adequate Maternal Pelvis

Question 8

What are the Types of Vaginal Breech Deliveries?

Answer 8

• Spontaneous
• PARTIAL Breech = Foetus descends spontaneously where umbilicus is at vaginal introitus; then it’s extracted completely
• TOTAL Breech = ENTIRE BODY is extracted!; Occurs if there’s evidence of Foetal Distress

Question 9

What are the 3 Mechanisms of Labor in Breech?

Answer 9

1) Delivery of Breech (Butt + Lower Legs) = Engage, Descent, Flexion –> Internal Rotation –> Birth of Butt

2) Delivery of Shoulders + Arms = Engage, Descent –> Internal Rotation –> Birth of Shoulder –> Restitution (rotate 45D to align)

3) Delivery of Head = Engage, Descent, Flexion –> Internal Rotation –> Birth of Head

Question 10

What are the Complications of Vaginal Breech?

Answer 10

• Cord Prolapse –> cause ASPHYXIA
• Birth Trauma - due to an extended arm / head
• Damage to Abdominal Organs
• Broken Neck

Question 11

What are the Maternal Complications?

Answer 11

RISK OF

• Operative Intervention
• Infection - from manipulations

Ruptured Uterus

Extension of Episiotomy

Post-Partum Haemorrhage