Breech_Presentation_Flashcards
What is a breech presentation?
In a breech presentation, the caudal end of the fetus occupies the lower segment.
How common is breech presentation at 28 weeks and near term?
Around 25% of pregnancies at 28 weeks are breech, but it only occurs in 3% of babies near term.
What is the most common type of breech presentation?
A frank breech is the most common presentation, with the hips flexed and knees fully extended.
What is a footling breech and why is it significant?
A footling breech, where one or both feet come first with the bottom at a higher position, is rare but carries a higher perinatal morbidity.
What are the risk factors for breech presentation?
Risk factors for breech presentation include uterine malformations, fibroids, placenta praevia, polyhydramnios or oligohydramnios, fetal abnormality (e.g., CNS malformation, chromosomal disorders), and prematurity.
Why is cord prolapse more common in breech presentations?
Cord prolapse is more common in breech presentations.
What is the management approach for breech presentation if less than 36 weeks?
If less than 36 weeks, many fetuses will turn spontaneously.
What is the recommended management if the fetus is still breech at 36 weeks?
If still breech at 36 weeks, NICE recommends external cephalic version (ECV) with a success rate of around 60%. The RCOG recommends ECV from 36 weeks in nulliparous women and from 37 weeks in multiparous women.
What are the delivery options if the baby remains breech?
If the baby is still breech, delivery options include planned caesarean section or vaginal delivery.
What information should be provided to women regarding planned caesarean section for breech presentation?
Women should be informed that planned caesarean section carries a reduced perinatal mortality and early neonatal morbidity for babies with a breech presentation at term compared with planned vaginal birth. However, there is no evidence that the long-term health of babies with a breech presentation delivered at term is influenced by how the baby is born.
What are the RCOG absolute contraindications to external cephalic version (ECV)?
RCOG absolute contraindications to ECV include situations where caesarean delivery is required, antepartum haemorrhage within the last 7 days, abnormal cardiotocography, major uterine anomaly, ruptured membranes, and multiple pregnancy.
summarise breech presentation
Breech presentation
In a breech presentation the caudal end of the fetus occupies the lower segment. Whilst around 25% of pregnancies at 28 weeks are breech it only occurs in 3% of babies near term. A frank breech is the most common presentation with the hips flexed and knees fully extended. A footling breech, where one or both feet come first with the bottom at a higher position, is rare but carries a higher perinatal morbidity
Risk factors for breech presentation
uterine malformations, fibroids
placenta praevia
polyhydramnios or oligohydramnios
fetal abnormality (e.g. CNS malformation, chromosomal disorders)
prematurity (due to increased incidence earlier in gestation)
Cord prolapse is more common in breech presentations
Management
if < 36 weeks: many fetuses will turn spontaneously
if still breech at 36 weeks NICE recommend external cephalic version (ECV)- this has a success rate of around 60%. The RCOG recommend ECV should be offered from 36 weeks in nulliparous women and from 37 weeks in multiparous women
if the baby is still breech then delivery options include planned caesarean section or vaginal delivery
Information to help decision making - the RCOG recommend:
‘Women should be informed that planned caesarean section carries a reduced perinatal mortality and early neonatal morbidity for babies with a breech presentation at term compared with planned vaginal birth.’
‘Women should be informed that there is no evidence that the long term health of babies with a breech presentation delivered at term is influenced by how the baby is born.’
RCOG absolute contraindications to ECV:
where caesarean delivery is required
antepartum haemorrhage within the last 7 days
abnormal cardiotocography
major uterine anomaly
ruptured membranes
multiple pregnancy
A 36-year-old multiparous woman is in advanced labour at 37 weeks gestation. An ultrasound confirms a breech presentation. She is fully dilated and has been pushing for an one and a half hours, however the buttocks are still not visible. How should this situation be managed?
Ventouse delivery
Non-rotational forceps
Caesarean section
Oxytocin infusion
External cephalic version
Caesarean section
Due to the foetal presentation and station, vaginal delivery is likely to be difficult. Breech extraction is not recommended for singleton pregnancies and requires considerable skill. Therefore Caesarean section should be advised.
A 26-year-old primigravida woman presents for an ultrasound scan at 34 weeks gestation. It is discovered that her baby is in the breech position.
What is the most appropriate course of action?
Book for Caesarean section at 38 weeks
Book for Caesarean section at 40 weeks
Offer immediate external cephalic version
Offer external cephalic version if still breech at 36 weeks
Offer external cephalic version if still breech at 38 weeks
Offer external cephalic version if still breech at 36 weeks
External cephalic version is recommended if the foetus is breech at 36 weeks
Before 36 weeks, it is likely that the foetus will move spontaneously into the correct position and it is therefore not necessary to perform this uncomfortable procedure before this time.
There is no need to immediately book the patient in for a Caesarean section, but if ECV is unsuccessful then a decision must be taken whether to go ahead with a breech presentation vaginal delivery, which carries a number of risks, or perform a Caesarean section.
