BREECH DELIVERY

Question 1

What is the definition of a Breech delivery?

Answer 1

An obstetric emergency whereby fetal buttocks or feet are the presenting feature.

Question 2

What are the three classifications of Breech?

Answer 2

Frank
Complete
Footling

Question 3

% of Breech that are Frank?

Answer 3

65%

Question 4

% of Breech that are Complete?

Answer 4

10%

Question 5

% of Breech that are Footling?

Answer 5

25%

Question 6

What is the incidence rate of Breech?

Answer 6

3-4% term deliveries & 25% of pre-term deliveries.

Question 7

What antenatal risk factors are there?

Answer 7

Prematurity
IUGR
SGA
Oligohydramnios
Multiple pregnancy

Question 8

What supporting evidence is there regarding prematurity and Breech deliveries?

Answer 8

Toijonen et al. (2019) 34,000 preterm deliveries = 4% breech

Question 9

What are some warning signs that Breech delivery may occur?

Answer 9

Felt in an EPA
Felt in an EPV
USS reports

Question 10

First steps taken when Breech occurs?

Answer 10

Call for help! (SOAPS).
Remove the end of the bed
Place mother into lithotomy position
Evaluate the need for an episiotomy.

Question 11

Who are SOAPS?

Answer 11

Senior Midwife
Obstetrician
Anaesthetist
Paeds/Neonatologist.
Scribe

Question 12

What is the need for SOAPS?

Answer 12

Senior midwife and obstetrician for expertise.
Anaesthetist is sometimes needed in case of a further emergency.
Paeds/Neonatologist to attend baby after birth.
Scribe to ensure accurate detail in notes.

Question 13

Second stage taken during a Breech delivery?

Answer 13

‘Hands off’ - allow spontaneous delivery of buttocks.

If needed, correct buttocks to sacroanterior.

Question 14

Third stage taken during a Breech delivery?

Answer 14

‘Hands off’ - allow spontaneous delivery of legs.

If needed, apply pressure to popliteal fossa to assist release of the legs.

Question 15

Fourth stage taken during a Breech delivery?

Answer 15

‘Hands off’ - allow spontaneous delivery of the body until the scapula is visible.

Question 16

Where is the scapulae?

Answer 16

Just below the shoulders.

Question 17

Fifth stage taken during a Breech delivery?

Answer 17

‘Hands off’ - allow spontaneous delivery of arms.

If needed, Lovsets manoeuver may be used.

Question 18

What is Lovsets manoeuver?

Answer 18

Fetus is rotated 90* -> pressure is placed on the antecubital fossa and the arm is swept across the body to be delivered -> repeat if needed for second arm.

Question 19

Sixth stage taken during a Breech delivery?

Answer 19

Let the baby hang until the nape of the neck is visible.

Question 20

Seventh stage taken during a Breech delivery?

Answer 20

Assist the delivery of the head using Mauriceau-Smellie-veit manoeuver (Obstetrician may use forceps instead).

Question 21

What is Mauriceau-Smellie-Veits manoeuver?

Answer 21

An arm is placed underneath the body of baby
Index finger and middle finger placed on malar bone and gentle pressure causes flexion.
Other hand -> middle finger placed on occiput

Question 22

Eighth stage taken during a Breech delivery?

Answer 22

the baby is delivered in an arc towards the mother’s

abdomen.

Question 23

After delivery, what should happen?

Answer 23

Baby to be reviewed by paed
Cord gases.
Debrief, Documentation & Datex

Question 24

How long between the delivery of the buttocks to head?

Answer 24

5 minutes.

Question 25

What is the % of serious perineal trauma, following a Breech dlivery?

Answer 25

58.5% - Hill (2019)

Question 26

What is the % of head entrapment, following a Breech presentation?

Answer 26

14% - Fischer (2022)