Breech presentation - GM

Question 1

normal (non-breech) presentation is called

Answer 1

cephalic

Question 2

types of breech presenation

Answer 2

complete (flexed) breech: one or both knees are flexed
footling (incomplete) breech: one or both feet present below the fetal buttocks, with hips and knees extended
frank (extended) breech: both hips flexed and bpth knees extended. babies born in frank breech are more likely to have developmental dysplasia of the hip

Question 3

complete (flexed) breech

Answer 3

Question 4

footling breech

Answer 4

Question 5

frank breech

Answer 5

Question 6

risk factors for breech presentation

Answer 6

maternal: multiparty, fibroids, previous breech presentation, Mullarian duct abnormalities
fetal: preterm, macrosomia, fetal abnormalities (anencephaly, hydrocephalus, cystic hygroma), multiple pregnancy
placental: placenta praevia, polyhydramnios, oligohydramnios, amniotic bands

Question 7

breech presentation before 36 weeks

Answer 7

not significant
fetus is likely to revert to a cephalic presentation
mother will often be asymptomatic and the diagnosis will be incidental

Question 8

clinical findings of a breech presentation

Answer 8

longitudinal lie
head palpated at the fundus
irregular mass over pelvis (feet, legs and buttocks)
fetal heart auscultated higher on the maternal abdomen
palpation of feet or sacrum at the cervical os during vaginal examination

Question 9

management options for breech presentation

Answer 9

external cepahlic version, vaginal delivery and caesarean section

Question 10

external cephalic version

Answer 10

manual rotation of the fetus into a cephalic presentation by applying pressure to the maternal abdomen under US guidance

Question 11

contraindications for undertaking external cephalic version include

Answer 11

antepartum haemorrhage
ruptured membranes
previous caesarean section
major uterine abnormality
multiple pregnancy
abnormal CTG

Question 12

risks of vaginal delivery

Answer 12

head entrapment
birth asphyxia
intracranial haemorrhage
perinatal mortality
cord prolapse
fetal and/or maternal trauma

Question 13

contraindications of vaginal delivery in breech position

Answer 13

footling breech: the babys head and trunk are more likley to be trapped if the feet pass through the dilated cervix too soon
macrosomia: usually defined as larger than 3800g
growth restricted baby: usually defined as smaller than 2000g
other complications of vaginal birth: for example, placenta praevia and fetal compromise
lack of clinical staff trained in vaginal breech delivery
previous caesarean section

Question 14

when to use caesarean section

Answer 14

most common management for breech presentation
c-section is preferred for preterm babies due to the increase head to abdominal circumference ratio in preterm babies
has fewer risks than vaginal delivery

Question 15

fetal complications of breech position

Answer 15

developmental dysplasia of the hip (DDH)
cord prolapse
fetal head entrapment
birth asphyxia
intracranial haemorrhage
perinatal mortality

Question 16

complications of external cephalic version

Answer 16

transient fetal heart abnormalities (common)
fetomaternal haemorrhage
placental abruption (rare)

Question 17

most common clinical findings for breech presentation

Answer 17

longitudinal lie
smooth metal head-shape at the fundus
irregular masses over the pelvis
abnormal placement being required for fetal heart auscultation