Breech Flashcards
Name the three different types of breech
Complete
Frank
Footling
What is the incidence of breech?
3-4% at term
Why is breech delivery best done on all fours?
Gravity
Increases pelvic diameter
Clear vision if manoeuvres required
Reduces second stage
What is breech?
Where the foetus presents either buttocks or feet first
Describe footling breech
Feet first
Describe complete (flexed) breech
Both legs are flexed at hips and knees - sitting cross legged with bum presenting
Describe frank (extended) breech
Bum first, both legs flexed at the hip and extended at the knee
What is the most common breech presentation?
Frank (extended)
At what gestation do we worry about breech?
> 32-35 weeks
List some risk factors for breech
Uterine
- multiparity
- uterine malformations
- Fibroids
- Placenta praevia
Fetal
- Prematurity
- Macrosomia
- Polyhydramnios - raised amniotic fluid index
- Twin pregnancy/or higher order
- Abnormality
How is breech presentation usually identified?
Clinical examination - palpation or if foetal heart auscultated higher on the maternal abdomen
How can breech present during labour?
Fetal distress
Meconium stained liquor
Vaginal examination - sacrum or foot felt through cervical opening
List the three main differentials of breech presentation
Oblique lie
Transverse lie
Unstable lie
What is oblique lie?
Foetus is positioned diagonally in the uterus with the head or buttocks in one iliac fossa
What is transverse lie?
Foetus is positioned across the uterus with head on one side of pelvis and buttocks on another
Shoulder is the presenting part
What is unstable lie
Where the foetus changes presentation from day-to-day
When is unstable lie more common?
Polyhydramnios
Multiparity
How should any suspected breech presentation be investigated?
Ultrasound
Describe the management of breech
External cephalic version (ECV)
Caesarean section
Vaginal breech delivery
Describe external cephalic version
Manipulation of the foetus to a cephalic presentation through the maternal abdomen
What is the percentage success rate of ECV?
40% in primiparous woman and 60% in multiparous woman
List the complications of ECV
Transient foetal heart abnormalities - which revert to normal
Persistent rare heart rate abnormalities- fetal bradycardia
Placental abruption
What is the risk of a woman needing C-section after ECV?
1/200
Who is ECV contraindicated in?
Recent APH
Ruptured membranes
Uterine abnormalities
Previous C-section
Which drug is given to relax the abdominal muscles before ECV?
Terbutaline
Which birthing position is favoured in breech?
Semi recumbent or on all fours
What kind of approach is required with breech delivery?
Hands off/poised
Which women should not be offered caesarean section
Near or in active second stage of labour
What is a contraindication to vaginal breech delivery
Footling breech - feet and legs can slip through a non dilated cervix and shoulders or head can be trapped
Which 3 manoeuvres can be used to assist vaginal breech delivery?
Flexing the foetal knees to enable delivery of the legs
Lovsett’s manoeuvure to rotate the body and deliver the shoulders
Mauriceau-smellie-veit manoeuvre
Describe the alignment of the baby to the mum when the mum is on all fours in breech delivery
Tum (baby) to bum (mum)
What is it called when the bum is presenting?
Rumping
How long do you have to get the baby out when it starts rumping?
7 minutes
List the complications of breech presentation
Cord prolapse (1% in breech compared to 0.5% in cephalic)
Foetal head entrapment
Premature rupture of membranes
Birth asphyxia
Intracranial haemorrhage
