Breech Presentation

Question 1

What is cephalic presentation ?

Answer 1

Head presents first

Question 2

What is the breech presentation. ?

Answer 2

Presenting part is legs or buttocks

Question 3

What are the 3 types of breech presentation ?

Answer 3

Extended (70%): legs are extended are the knee; flexed (15%): legs are flexed at the knee; Footling (15%): one or both of the legs present below the buttocks (high risk of cord prolapse)

Question 4

What is the umbilical cord ?

Answer 4

Cord that runs from the belly button to placenta

Question 5

What are the complications of a breech pregnancy ? (2) 😭

Answer 5

1. Perinatal mortality and morbidity due to intrapartum problems: cord prolapse and head entrapment
2. Congenital abnormalities: neurological handicap

Question 6

What is the mnemonic for the risks for breech presentation and state what they are ? (7) 😭

Answer 6

Most cases are idiopathic and they are common in preterm babies. Only affects 3-4% of term babies
TUPO: Twins; Uterine fibroids/fetal abnormalities; Pelvic tumours/deformities/obstruction, previous breech, placenta praevia, polyhydraminos and Oligohydramnos

Question 7

What is polyhydraminos ?

Answer 7

Excess amniotic fluid

Question 8

What is oligohydraminos ?

Answer 8

Lower level of amniotic fluid for gestational age

Question 9

If the Women is below 36 weeks what would you say to her

Answer 9

If below 36weeks reassure and mention that the baby can turn to a cephalic presentation and come back at 36 weeks

Question 10

Describe the management options for a breech presentation

Answer 10

Discuss external cephalic version at 3weeks is first line provided no contraindications
Alternatives: elective c-section (39 weeks) and vaginal birth

Question 11

When is ECV performed ?

Answer 11

At 36 weeks for nulliparous: 37 weeks for mulitparous, provided there are no contraindications

Question 12

What is the mnemonic for the contraindications for ECV and state what they are ? 😭

Answer 12

FARTP; Fetal compromise, APH + placenta praevia; Ruptured membranes (water broken), Twins and previous c-section (classical or vertical)

Question 13

What is ECV ?

Answer 13

External cephalic version is a procedure performed by an obstetrician at 37 weeks under US guidance, where gentle pressure is applied to the tummy in an attempt to turn the baby so that their head lies first

Question 14

Reasons for ECV

Answer 14

Breech presentation

Question 15

What are the procedure details ?

Answer 15

Before: check rhesus status and if negative give you anti D
During: give you a uterine relaxant but no anaesthetics are given
After: can distress the baby so fetal CTG is performed

Question 16

What are the benefits of ECV ? (3)

Answer 16

50% success rate which means there there is also a possibility of it failing so baby remains in breech position
Reduces the risk of intrapartum problems
Less risky than a c-section or vaginal birth

Question 17

What are the risks of ECV ?

Answer 17

1. Small risk of induction of labour and if this the case you will need to have an emergency c-section (don’t worry we will be in hospital)
2. Umbilical cord entanglement
   3: placental abruption (haemorrhage/Bleeding)

Question 18

Safety netting

Answer 18

If you go into labour, it’s important you come to hospital immediately as there is a high of cord prolapse

Question 19

Alternatives to ECV

Answer 19

Elective c-section and vaginal birth

Question 20

What is the benefit (1) and risk(2) of have an elective c-section for a breech pregnancy ? 😭

Answer 20

Benefits: Safer for your baby than a vaginal delivery
Risks: (2)
1. more risky for you
2.Increases your chances of problems for future pregnancies

Question 21

What are the benefits (1) and risks of having a vaginal surgery (2) ?

Answer 21

Benefits: More safer for you
Risks: 1. small risk you may need emergency c-section
2. Risk of intrapartum problems (cord prolapse and head entrapment)