Breech

Question 1

Define breech presentation

Answer 1

Fetus presents buttocks or feet first (rather than head first – a cephalic presentation)

Question 2

Why is breech presentation such a risk?

Answer 2

Higher perinatal mortality and morbidity, largely due to birth asphyxia/trauma, prematurity and an increased incidence of congenital malformations

Question 3

Name the types of breech presentation

Answer 3

Complete (flexed) = both legs flexed at hips and knees

Frank (extended) = both flexed at hip, extended at knee

Footling = one or both legs extended at the hip, so that the foot is the presenting part

Question 4

How is breach presentation normally identified?

Answer 4

On abdo palpation = round fetal head felt in upper uterus and fetal buttocks/legs in the pelvis

It can also be identified in the fetal heart is auscultated higher in the abdo

Question 5

How should suspected breech presentation be confirmed?

Answer 5

USS

Question 6

Outline how breech presentation should be managed?

Answer 6

External cephalic version = manipulation of the fetus to a cephalic presentation through the maternal abdomen

Caesarean section = is ESV is unsuccessful

Vaginal breech birth

Question 7

List the possible complications from breech presentation

Answer 7

At delivery

• Cord prolapse = umbilical cord drops down below the presenting part of the baby, becomes compressed
• Fetal head entrapment
• Birth asphyxia – usually sec to a delay in delivery
• Intracranial haemorrhage – rapid compression of the head during delivery

Premature rupture of membranes