Breech Presentation

Question 1

What is it?

Answer 1

The fetus is bum first as opposed to the usual cephalic

Question 2

Causes and associations

Answer 2

Uterine abnormalities (e.g. bicornuate uterus, fibroids)
Prematurity
PP
Oligohydramnios
Fetal abnormalities (e.g. hydrocephalus)
Multiples

Question 3

Risks to baby - 2

Answer 3

Risk of trauma to baby

Hypoxia during birth

Question 4

Other non-cephalic presentations

Answer 4

Transverse

Oblique

Question 5

Types:

Extended (frank)

Flexed (complete)

Footling (incomplete)

Which type has the greatest risk of cord prolapse?

Answer 5

Flexed hips but extended knees (straight legs)

Hips and knees flexed

One/both hips extended
With foot/feet dangling down

Footling (incomplete)

Question 6

How would a diagnosis be made?

Answer 6

USS
Feeling during labour
Balloting head in fundus

Question 7

Management:

ECV:

• What is it?
• At what gestation is this done?

What if ECV is unsuccessful?

Answer 7

External cephalic version

37 wks

CS at 39 wks

Question 8

Vaginal breech delivery:

What should the birth attendant make sure not to do while the baby is being pushed out?

What type of dislocation should be looked for at 6 wks?

Answer 8

Handoff technique until baby’s scapulae are visible

Hip dislocation

Question 9

Other malpresentations/malpositions:

Occipitoposterior position:

• What does this mean?
• What would be felt on vaginal examination?
• Why is an epidural recommended?

Other malpresentations that will need CS?

Answer 9

Back of head is facing towards mother bottom

Posterior fontanelle found in the posteior quadrant of pelvis

Face presentation
Brow presentation
Transverse lie (compound shoulder presentation)