Antenatal Care - Breech Presentation

Question 1

What is Breech Presentation?

Answer 1

Presenting Part of Foetus is Legs and Bottom (not Cephalic = Head).

Question 2

Types of Breech (4).

Answer 2

1. Complete - Legs are fully flexed at hips and knees.
2. Incomplete - One leg is flexed at the hip and extended at the knee.
3. Extended/Frank - Both legs are flexed at the hip and extended at the knee (commonest).
4. Footling Breech - Foot is presenting through cervix with leg extended.

Question 3

Management of Breech Presentation (3).

Answer 3

1. Before Week 36 : Turn spontaneously = no intervention.
2. ECV (External Cephalic Version) after week 36 in primiparous; after week 37 in multiparous.
3. Choice of Vaginal Delivery vs. Elective Caesarean Section.

Question 4

What is ECV?

Answer 4

A technique used to attempt to turn a foetus from the breech position to a cephalic position using pressure on the pregnant abdomen. Accompanied with Tocolysis and Anti-D Prophylaxis.

Question 5

Tocolysis Profile :
- Aim.
- Method.

Answer 5

Aim : Relax Uterus before ECV.
Method : SC Terbutaline (B-Agonist) to reduce contractility of Myometrium making it easier for baby to turn.

Question 6

Anti-D Prophylaxis Profile :
- Test.
- Indication.

Answer 6

Test : Kleihauer - quantify how much foetal blood is mixed with maternal blood to determine dose of Anti-D required.
Indication : Rhesus-D Negative Women.

Question 7

Risk Factors of Breech Presentation (5).

Answer 7

1. Uterine Malformations e.g. FIbroids.
2. Placenta Praevia.
3. Olgio/Polyhydramnios.
4. Foetal Abnormality.
5. Prematurity.

Question 8

Absolute Contraindications to ECV (6).

Answer 8

1. C-Section Delivery is Required.
2. APH within last week.
3. Abnormal CTG.
4. Major Uterine Anomaly.
5. Ruptured Membranes.
6. Multiple Pregnancy.