Breech Flashcards
Define breech presentation
When the buttocks or legs of the fetus enter the pelvis
before the head
T/F
Breech is more common when remote (preterm) from term
True
How many percent of breech presentation persist at term in singleton deliveries as the fetus turns spontaneously to cephalic presentation?
3-4% only
Reason why there is breech presentation
Fetus’s biparietal diameter is larger than breech “buttocks” so it would seek a more spacious hole which is the fundus, AT TERM.
3 Categories of Breech Presentation
Frank, Complete, Incomplete
The buttocks present in the introitus,
the thighs are FLEXED towards the lower
abdomen, and the legs are EXTENDED.
Frank
The thighs are FLEXED towards the lower
abdomen, and the legs are FLEXED
towards the thighs.
“Indian sit”
Complete
Reference point in all breeches
Sacrum
One or both thighs are FLEXED or
EXTENDED, and one foot is EXTENDED.
Incomplete
If the sacrum is palpated in Incomplete breech at the level of ischial spine, what is the station?
Station 0
Give 4 Risk factors for breech presentation
Greater intrauterine surface area Congenital anomaly Decreased surface area at the lower intrauterine segment Prior occurrences (Prior breech and prior CS)
Explain why greater surface area is a risk factor
There is a high probability that the fetus will tumble around the uterus especially in the setting of premature gestational age, abnormal amniotic fluid volume, high parity with uterine relaxation
Explain why congenital anomaly is a risk factor
Hydrocephaly and Anencephaly will seek a more spacious fundal pole
Explain why decreased surface area at the lower uterine segment is a risk factor
In setting of multifetal gestation Fundal placental implantation Uterine/ Mullerian Anomalies (Bicornuate uterus or uterine didelphus) Pelvic tumor Placenta previa
Decreased surface area will seek a more spacious fundal pole
Diagnosis of Breech Delivery
Leopold’s Maneuver
Fetal Heart Sound
Vaginal Examination
Leopold’s Maneuver
L1 means
the fetal head will be felt as ballotable, hard
round mass, found to occupy the fundus
What is the meaning of ballotable/ ballotment
“Bouncing back”
Leopold’s Maneuver
L2 means
the same as in cephalic, the fetal back on one
side of the abdomen and fetal small parts on the
other will be felt
Leopold’s Maneuver
L3 means
if engagement has not occurred, the
intertrochanteric diameter of the fetal pelvis has not
passed through the pelvic inlet. The breech is movable
above the pelvic inlet.
The breech will be felt as a very large podalic pole,
softer than the head.
Leopold’s Maneuver
L4 means
after engagement, the firm breech is beneath
the symphysis
In breech, it is heard loudest slightly at?
Above the umbilicus (upper segment)
because the head is up with
the upper torso
In cephalic, it is heard loudest at?
LUS because that
is where the fetal back is
In vaginal exam, what will you palpate for frank breech?
Ischial tuberosities, sacrum and anus
Anus can be mistaken as?
Mouth
Ischial Tuberosities can be mistaken as?
Malar eminences
Difference in configuration of palpable ischial tuberosities and anus in breech vs cephalic?
Breech- straight line configuration
Cephalic- triangular (Malar eminence not ischial tuberosities)
Most accurate information that will establish the diagnosis of position
Sacrum and its spinous process
How will you know if it is the mouth or the anus that you are palpating?
Mouth of the baby will have pursing movement, anus will not.
In vaginal exam, you know it’s complete breech when?
Feet maybe alongside the buttocks if you push a little bit more beyond the ischial tuberosities/sacrum/anus
