Antenatal Care - Breech Presentation

Question 1

What is Breech Presentation?

Answer 1

The presenting part of the foetus is the legs and bottom - opposite of Cephalic Presentation.

Question 2

Types of Breech (4).

Answer 2

1. Complete - Legs are Fully Flexed at Hips and Knees.
2. Incomplete Breech - One Leg is Flexed at the Hip and Extended at the Knee.
3. Extended/Frank Breech - Both Legs Flexed at Hip and Extended at Knee (commonest).
4. Footling Breech - Foot is Presenting Through Cervix with Extended Leg.

Question 3

Risk Factors of Breech Presentation (5).

Answer 3

1. Uterine Malformations e.g. Fibroids.
2. Placenta Praevia.
3. Poly/Oligohydramnios.
4. Foetal Abnormality e.g. CNS Malformation.
5. Prematurity.

Question 4

Management of Breech Presentation (3).

Answer 4

1. Breech before Week 36 - no intervention (spontaneous turn).
2. ECV at term (37 weeks).
3. If ECV fails, Vaginal Delivery or Elective C-Section.

Question 5

Breech in Twin Pregnancy.

Answer 5

If the first baby in a twin pregnancy is breech, C-Section is required.

Question 6

What is ECV?

Answer 6

External Cephalic Version - attempt to turn a foetus from breech to cephalic using pressure on the pregnant abdomen.

Question 7

Indications of ECX (2).

Answer 7

1. Nulliparous - after week 36.

2. Parous - after week 37.

Question 8

What measures should be taken with ECV? (2)

Answer 8

1. Tocolysis with SC Terbutaline - Relax Uterus before Procedure.
2. Rhesus-D Negative (Anti-D Prophylaxis with Kleihauer Test).

Question 9

Absolute Contraindications of ECV (7).

Answer 9

1. C-Section is Required Anyway.
2. APH within Last 7 Days.
3. Abnormal CTG.
4. Major Uterine Anomaly.
5. Ruptured Membranes.
6. Multiple Pregnancy.
7. Placental Abruption/Praevia.