Breech

Question 1

Risk factors for breech pregnancy

Answer 1

First pregnancy - nulliparous
Placenta praevia
Multiple pregnancy
Poly or oligohydramnios
Uterine abnormalities e.g. fibroids
Multiparity - leading to lax uterus

Question 2

Types of breech

Answer 2

Complete - legs fully flexed at the hips and knees

Incomplete - where one of the legs is flexed at the hip and extended at the knee

Frank breech - both legs flexed at the hip and extended at the knee

Footling breech - foot/feet presenting through the cervix (the foot or feet are below the bottom)

Question 3

Management of breech

Answer 3

Wait until 36 weeks as breech babies often turn spontaneously before 36 weeks

ECV -

• After 36 weeks in nulliparous women
• After 37 weeks in women who’ve given birth previously
• Terbutaline tocolysis given before to relax the uterus before the procedure
• Rhesus negative women need anti-D prophylaxis and a Kleihauer test
• About 50% effective

If ECV fails:

• Choice between vaginal delivery and c-section
• C-section is safer for the baby, vaginal delivery is safer for the mother
• there is a fairly high risk of needing an emergency c-section when vaginal birth is attempted

First twin breech = c-section

Question 4

Contraindications to ECV

Answer 4

Previous APH
IUGR 
Abnormal CTG
Multiple pregnancy
Membranes have broken

Question 5

Risks of breech presentation

Answer 5

Cord prolapse - if go into labour need to go to hospital ASAP due to risk of cord prolapse

May need emergency c-section