Breech Birth

Question 1

What is ‘term’ defined as?

Answer 1

37-42 weeks’ gestation.

Question 2

At term, what percentage of women will have a baby in a breech presentation?

Answer 2

3-5%.

Question 3

At 28 weeks’ gestation, what percentage of women will have a baby in a breech presentation?

Answer 3

20%.

Question 4

What is another term for complete breech?

Answer 4

Flexed breech.

Question 5

In which variation of a breech presentation are the feet and bottom closest to the birth canal?

Answer 5

Complete breech.

Question 6

In which variation of a breech presentation are one of the knees bent, so only one foot and the bottom are closest to the birth canal?

Answer 6

Incomplete breech.

Question 7

In which variation of a breech presentation are the baby’s legs folded flat up against the head, with the bottom closest to the birth canal?

Answer 7

Frank breech.

Question 8

What is the most common type of breech presentation?

Answer 8

Frank breech.

Question 9

Frank breech presentations occur in what percentage of term breech births?

Answer 9

45-50%.

Question 10

It is thought that frank breech presentations are common among which women?

Answer 10

Primigravidae.

Question 11

In what variation of a breech presentation are the legs fully extended, with the feet closest to the birth canal?

Answer 11

Footling breech.

Question 12

A footling breech is not to be confused with what?

Answer 12

A dropped foot.

Question 13

What variation of a breech presentation will not deliver?

Answer 13

A footling breech.

Question 14

In what variation of a breech presenation are the thighs extended, but knees flexed, with one or both knees closest to the birth canal?

Answer 14

Kneeling breech.

Question 15

Does breech birth have a high incidence of recurrence?

Answer 15

Yes.

Question 16

On antenatal abdominal palpation, where would the head be felt?

Answer 16

A hard, ballotable head would be felt at the fundus.

Question 17

Where would you expect to auscultate the fetal heart in a breech presentation?

Answer 17

At or above the umbilicus.

Question 18

A suspected breech is not an issue until how many weeks’ gestation?

Answer 18

36 weeks’.

Question 19

If a breech presentation is confirmed on ultrasound after 36 weeks, women are usually offered what?

Answer 19

External cephalic version (ECV).

Question 20

What drug is administered for an ECV? What is the dose and what is the route?

Answer 20

Terbutaline (250mcg) subcutaneous injection.

Question 21

What are three risks associated with ECVs?

Answer 21

Cord prolapse, early rupturing of membranes and placental abruption.

Question 22

What complementary therapies can be used to encourage movement of the fetus from a breech to cephalic presentation?

Answer 22

Homeopathy, acupuncture, moxibustion, reflexology and maternal positioning.

Question 23

In a breech presentation, the gluteal cleft can be mistaken for what upon vaginal examination?

Answer 23

The sagittal suture (if membranes are intact).

Question 24

If the breech is applied to the cervix asynclitically, what may be mistaken for the fetal skull upon vaginal examination?

Answer 24

The trochanter.

Question 25

Emergency caesarean sections occur in what percentage of cases where vaginal breech births were planned?

Answer 25

40%.

Question 26

What is the incidence of perinatal mortality for a vaginal breech birth? What is the incidence of perinatal mortality for a vaginal cephalic birth?

Answer 26

2/1000.

1/1000.

Question 27

Is an artificial rupture of membranes indicated in vaginal breech births?

Answer 27

No, ARMs should not be performed due to the risk of cord prolapse.

Question 28

How long is the bi-trochanteric diameter?

Answer 28

10cm.

Question 29

How long is the bi-sacromial diameter?

Answer 29

11cm.

Question 30

Within how many minutes from ‘rumping’ should the baby be born?

Answer 30

7 minutes.

Question 31

After the buttocks are born, the baby will rotate externally into what position?

Answer 31

‘Tum to mum’s bum’.

Question 32

What aids flexion of the fetal head?

Answer 32

Tummy tucks.

Question 33

What are the two possible engaging diameters of the fetal head in a breech birth?

Answer 33

The sub-occipitobregmatic (9.5cm) or the sub-occipitofrontal (10cm).

Question 34

Internal rotation of the head in a breech birth brings the _______ behind the symphysis pubis, and the ____ lies in the hollow of the sacrum/

Answer 34

occiput

face