Breech presentation and abnormal lie

Question 1

Risk factors

Answer 1

Preterm delivery
Small for dates
Primiparity
Congenital anomalies
Abnormal amniotic fluid volume
Placental and uterine abnormalities
Previous breech deliveries
Multiple pregnancy

Question 2

Types of breech presentation

Answer 2

Frank - buttocks, legs straight
Footling - feet first
Complete - buttocks, legs bent

Question 3

Clinical assessment of foetal lie

Answer 3

Leopold manoeuvre (palpate head, spine and extremities, locate presenting part and determine how far descended and if engaged)
Locate foetal heartbeat
Pelvic exam (type of breech presentation, position of fetal sacrum, assess for cord loops)
Digital examination should not be performed if suspicion of placenta praevia

Question 4

Investigations

Answer 4

US scan:
Confirm diagnosis
Establish type
Exclude causative factors (polyhydramnios, placenta praevia, foetal anomaly

Question 5

Management <37w

Answer 5

Not in labour, intact membranes: review after 37w unless reason to expedite delivery; preferred route C-section
In labour: delivery depends on gestation; fetal abnormality; progress of labour; fetal status; type of breech

Question 6

Management >37w

Answer 6

Before labour: External cephalic version; C-section
In labour: C-section; vaginal breech delivery if delivery imminent; ECV considered if membranes intact and delivery not imminent