Breech

Question 1

Frank breech

Answer 1

Hips are flexed and legs extended

• toes next to face

Question 2

Complete breech

Answer 2

Hips and knees flexed and the feet are not below the level of the fetal buttocks

• sitting crosslegged

Question 3

Footling breech

Answer 3

One or both feet are presenting as the lowest part of the fetus

• extended legs, like standing

Question 4

Associations and causes of breech (maternal factors)

Answer 4

• polyhydramnios/oligohydramnios
• uterine anomalies (bicornuate, septate)
• space occupying lesions (fibroids)
• placental abnormalities (praevia, cornual)
• contracted maternal pelvis
• multiparity (in particular grand multips)

Question 5

Associations and causes of breech (fetal factors)

Answer 5

• prematurity
• fetal anomalies (neurological, hydrocephalus, anenecephaly)
• multiple pregnancy
• fetal death
• short umbilical cord

Question 6

Breech is suspected if…

Answer 6

• abdominal palpation (presenting part is irregular, not ballotable OR head ballotable at fundus of uterus)
• pelvic examination (head not felt in pelvis - buttocks or feet instead)
• very thick meconium present after rupture of membranes
• cord prolapse
• abnormal CTG
• fetal heart heard higher in abdomen

Question 7

Confirm Breech presentation by

Answer 7

Ultrasound scan for diagnosis

• exclude causative factors (polyhydraminos, low lying placenta, fetal anomaly)

Question 8

When do we start worrying about a breech presentation?

Answer 8

No further mx in the uncomplicated pregnancy is required until 37 weeks gestation.

Breech presentation is normal in preterm pregnancy, often times fetus converts to cephalic presentation on their own.

Question 9

Intrapartum care of breech - recommended mode of delivery in emergency?

Answer 9

Emergency Caesarean Section for preterm labour with breech presentation. –> book for 39 weeks gestation if no emergency

unless: vaginal birth imminent OR medical circumstance where survival of fetus unchanged by mode of delivery (24-25wk gestation, lethal condition) OR maternal morbidity of C section judged to be too great for relative potential fetal disadvantages

Question 10

ECV, when is it offered and if unsuccessful what then?

Answer 10

External Cephalic Version

• offered at term (so if brings on labour, baby is ready)
• if unsuccessful elective caesarean section booked for 39 weeks gestation

Question 11

Vaginal breech birth, main complication is:

Answer 11

Cord prolapse.

• lowermost parts of baby not completely filling space of dilated cervix
• when waters break the amniotic sac, umbilical cord could drop down and become compressed
• diminishes oxygen flow to baby (must be delivered immediately)

Question 12

Vaginal birth can only be done in which types of Breech?

Answer 12

Frank or complete breech

• rump of fetus can slow amniotic fluid loss and hence decrease cord prolapse chance

Question 13

Name the 3 classifications of breech

Answer 13

Frank breech
Complete breech
Footling breech