Breech presentation Dr shatha sami alyasrri Assisstant professor

Breech presentation Dr. shatha sami alyasrri Assisstant professor FICOG CABCOG

Definition: is a polar alignment of the fetus in which the fetal buttocks present at the maternal pelvic inlet. • Incidence: 3 -5%

: 60 -65% 25 -35% 5%

Predisposing factors presentation for breech 1. Fibroids. 2. Congenital uterine abnormalities (e. g. bicornuate 3. Multiple gestation. 4. Prematurity. 5. Placenta praevia. 6. structural Abnormality (e. g. anencephaly or hydrocephalus). 7. Fetal neuromuscularcondition. 8. Oligohydramnios. Polyhydramnios. uterus).

Diagnosis 1. Examination: Abdominal Leopold’s first-head in the fundus Leopold’s third-no tapering b/n the buttocks and the body Auscultation-FHR in the upper quadrants

Vaginal : frank: anal orifice, ischial tuberosities and no feet. • -Complete: anal orifice, ischial tuberosities & feet above the buttock Incomplete: one or more feet/knees felt •

2. Ultrasound: in difficult cases and to see associated anomalies, weight estimation and fetal attitude

Antenatal management of breech presentation The three management options available should be discussed with the woman: 1. external cephalic version 2. vaginal breech delivery 3. elective caesarean section. (ECV)

external cephalic version ♦The procedure is performed at or after 37 completed weeks’gestation by an experienced obstetrician at deliveryfacilities. ♦ECVshould be performed witha tocolytic (e. g. nifedipine) ♦under uls guide ♦anti D should be given ♦exclude contraindication

Perinatal mortality Feared and serious complication in breech • Four fold higher than cephalic. • Malformations: NTD, hydrocephaly, trisomie • Trauma: no time for molding leading to head entrapment hyperextension of neck leads to injury • • Asphyxia: cord prolapse(0. 4%, 5%, 10%)

Cesarean delivery • EFW <1, 500 or >4, 000 g • Footling presentation • Small pelvis • Hyperextended fetal head • Absence of expertise • Nonreassuring fetal heart rate pattern • Arrest of progress

Vaginal delivery Three types: • A spontaneous breech delivery infant delivers vaginally without manual aid. is one in which the entire • The assisted breech delivery( partial breech extraction. In this delivery, the fetus is allowed to deliver until the fetal umbilicus has passed over the mother's perineum. A complete breech extraction, in which manual assistance is applied by traction in the groins or on the lower extremities before delivery of the buttocks

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