Antenatal - Breech

Question 1

what is breech presentation?

Answer 1

refers to when the presenting part of the fetus is the legs and bottom

occurs in less than 5% of pregnancies by 37 weeks

Question 2

what are the types of breech presentation?

Answer 2

• Complete breech, where the legs are fully flexed at the hips and knees
• Incomplete breech, with one leg flexed at the hip and extended at the knee
• Extended breech, also known as frank breech, with both legs flexed at the hip and extended at the knee
• Footling breech, with a foot is presenting through the cervix with the leg extended

Question 3

how is breech managed?

Answer 3

before 36 weeks babies often turn spontaneously so no intervention is advised

external cephalic version (ECV) can be used at term to attempt to turn the fetus

when ECV fails women are given a choice between vaginal delivery and elective caesarean section (VD needs experienced midwives and obstetricians with access to emergency theatre)

vaginal is safer for mother

cs is safer for baby

40% chance of requiring emergency section where vaginal is attempted

when first baby of twins in breech - cs is required

Question 4

what is ECV and when can it be used?

Answer 4

ECV is a technique used to attempt to turn the fetus from the breech position to the cephalic position using pressure on the pregnant abdomen

50% successful

used in breech babies: after 36 weeks for nulliparous women and after 37 weeks in women who have previously given birth

Question 5

how is ECV done?

Answer 5

woman is given tocolysis (a sub cut terbutaline, a beta agonsit) to relax uterus which reduced contractility of the myometrium

Question 6

what needs to happen to rhesus negative women who undergo ECV?

Answer 6

require anti-D prophylaxis

Kleinhauer test to quantify how much fetal blood is mixed with maternal blood to determine dose