Breech Birth

Question 1

Definition

Answer 1

When the buttocks and/or feet are the presenting part and in the lower uterine segment and first to engage when labour commences.

Question 2

Incidence

Answer 2

3-4% of pregnancies at term. Incidence decreases decreases as gestational age increases.

Question 3

Risk factors

Answer 3

Uterine malformation
Uterine fibroids
Prematurity
Multiple pregnancy
Previous breech
Lax uterus

Question 4

Complications

Answer 4

• Hypoxia
• Head entrapment
• Cord presentation
• Fractured clavicle

Maternal

• Prolonged labour
• Urethra or perineal trauma
• Psychological distress if unexpected

Question 5

Help

Answer 5

Senior midwife - aware of what is going on and can organise in case of theatre
Obs on standby - in case of fetal compromise
Anaesthetist - In case of theatre
Paed - If fetal compromise arises
Skilled attendant - To deliver baby safely

Question 6

Labour care and role of midwife

Answer 6

• Normal labour
• CTG monitoring
• Cannulate and bloods (FBS and GROUP&SAVE)
• VE to confirm full dilatation
• Assess contraction
• Consider epis
• Bladder care
• Communicate with women and inform of risks

Question 7

Maternal position

Answer 7

Semi recumbent at end of bed, or all 4’s if comfortable.

Question 8

Mechanism of right sacroanterior posititon

Answer 8

Lie - Longitudinal
Attitude - complete flexion
Presentation - Breech
Position - right sacroanterior 
Denominator - Sacrum
Presenting part - anterior right buttock

Bitrochanteric diameter of 10cms (hips) enter right oblique diameter of pelvic brim which is 12 cm

Question 9

Internal rotation of buttocks

Answer 9

Anterior buttock rotates 1/8th anticlockwise in pelvic floor, sacrum now transverse under symphysis pubis

Lateral flexion of trunk - To adapt to curve of carus. Anterior buttock descends and appears at Introits followed by posterior buttock

Restitution of buttocks - Buttocks delivered, shoulders enter pelvic inlet with bisacromial (shoulders) diameter in transverse. External rotation of delivered buttocks so fetal back now on front.

Question 10

Internal rotation of shoulders

Answer 10

Bisacromial diameter 11cms enter right oblique diameter of pelvic brim. Anterior shoulder rotates 1/8th anticlockwise and hinges under symphysis pubis.

Posterior shoulder and arm sweep perineum and shoulders are born.

Buttock restitutes 90 degrees clockwise and head is engaging

Question 11

Internal rotation of head

Answer 11

Fetal head with suboccipitobregmatic 9.5cms engages in transverse of pelvic brim.
Occiput rotates 1/8th at pelvic floor along left side of pelvis.
Face in hollow of sacrum, nape of neck impinges underside of symphysis pubis. Neck, face and occiput born.

Question 12

Emergency manouvres - Extended legs

Answer 12

• Index finger behind knee
• Gentle pressure upwards causing knee to flex and ankles to come down
• Assist by sweeping it to side of abdomen
• Can be repeated on other leg

Question 13

Emergency manouvre - Extended arms

Answer 13

LOVESETS

Baby held at iliac crest with thumbs on sacrum and back must be uppermost.

Rotate 90 degrees anticlockwise, place finger on shoulder and follow along to find antecubital fossa and flex arm.

Rotate baby 180 degrees clockwise and repeat the same

Question 14

Emergency manouvre - Head

Answer 14

MAURICEAU-SMELLIE-VEIT

Head should be flexed.

Straddle baby on non dominant arm, place a finger on each maxillary bone.

With opposite hand place middle finger on occiput above nape of neck and fore and ring finger on shoulder .

Encourage flexion and sweep baby face over perineum.

Question 15

Aftercare

Answer 15

• Active management of 3rd stage
• Suture perineum
• Minimise heat loss for baby, vit k, early feed, cord gases, hip scan and top to toe exam
• Debrief for mum

Document

• Who was present
• Emergency manouvres performed
• Time of birth
• Incident form