Breech Presentation

Question 1

Define breech presentation?

Answer 1

When the buttocks is the 1st presenting part.

Only significant after 36 weeks as before this the foetus is moving and can change position easily.

Question 2

What are the different classifications of breech presentation and how common are they?

Answer 2

Frank/extended: Both legs are extended bum first 70%
Flexed: knees tucked in 15%
Footing: Foot first 15%

Question 3

What are the risk factors for a breech presentation?

Answer 3

General rule:

• Restricted space (can’t turn round into the correct position)
• Too much space therefore doesn’t stay in correct position

Other RF include:

• Prematurity
• IUGR
• Multiple gestation
• Polyhydraminos
• Placenta previa

Question 4

What are the complications of breech presentation?

Answer 4

Increased risk of hypoxia and trauma during vaginal delivery therefore many have C-section

Increased cord prolapse, trapped head

Question 5

What are the potential management options for a lady with a breech presentation?

Answer 5

External cephalic version
Vaginal delivery of breech
C-section

Question 6

How is cephalic external version performed?

Answer 6

It is performed after 36 weeks.

Essentially attempting to turn the foetus round by manual palpation through the maternal abdomen.

Before the procedure an USS and CTG are performed.

An injection of tocolysis (short acting beta agonist to relax the uterus).

After the procedure a repeat CTG is done.

Give anti D if aplicable

Question 7

How successful is ECV and what factors may make it more successful?

Answer 7

50% most common reason for it not being successful is mother not being able to cope with the pain of the procedure.

More successful if:
Frank breech
Not engaged
Normal quantity of amniotic fluid
Multiparous, thin mother

Question 8

What are the absolute contraindications of ECV?

Answer 8

Already indication for CS
APH
Fetal compromise
Oligohydraminos

Question 9

What conditions can vaginal breech delivery be done under?

Answer 9

Baby: 
Frank Breech 
Term delivery
Estimated fetal weight 2.5-3.5kg
Absence of fetal distress
Head is not hyperextended

Mother:
Progressing well in pregnancy

Clinician:
Experienced operator
Adequate anaesthesia (often epidural)
Capacity for emergency CS if needed