BREECH PRESENTATION ELIZABETH CHODZAZA BARBARA D MLEWAH MELANIE

BREECH PRESENTATION ELIZABETH CHODZAZA BARBARA D. MLEWAH MELANIE HAMI 2010

LEARNING OUTCOMES • To define breech presentation • To explain the causes and predisposing factors to a breech presentation • To be able to diagnose a breech presentation • To describe the types of breech presentation • To describe the mechanism of labor of a breech presentation

LEARNING OUTCOMES conti… • To explain the specific first management of a woman with breech presentation • To explain the management of breech presentation in second stage • To explain the complications of a breech presentation

DEFINITION • Breech presentation is when the foetus lies longitudinally with the buttocks in the lower pole of the uterus. • The presenting diameter is the bitrochanteric diameter (10 cm).

CAUSES/PREDISPOSING FACTORS Multi-parity Poly-hydramnios Prematurity Multiple gestation Uterine deformities Placenta praevia Fetal congenital abnormalities

DIAGNOSIS Mother may report: • Increased foetal movements in the lower uterine pole • Hard and uncomfortable thing under her ribs which causes difficulties in breathing and pain

DIAGNOSIS conti. . Palpation • foetal head is felt hard, round and ballotable in the fundus of the uterus Auscultation Foetal heart is heard most clearly above the umbilicus Ultra sound examination • The foetal head will be seen on the uterine fundus

DIAGNOSIS conti. . X-ray Vaginal examination • a soft and irregular presenting part with no sutures. • The sacrum may be mistaken for a hard head and buttocks mistaken for caput succedaneum • Anus may be felt and fresh meconeum seen on the examining gloves • Toes may be felt in footling breech

SPECIFIC MANAGEMENT IN FIRST STAGE OF LABOUR • Basic management is the same as in normal labor. • Referring to district hospital for delivery if at a health center Administer sedatives (pethidine) Encourage upright positions. Give IV fluids.

SPECIFIC MANAGEMENT IN FIRST STAGE OF LABOUR cont…. When there is SRM do vaginal examination Explain to mother to avoid premature pushing Accurate assessment of the size of breech Monitor maternal and fetal condition closely Prepare the delivery trolley, an episiotomy set, and resuscitation material.

MANAGEMENT OF SECOND STAGE Preparation • Ensure there is some one to assist • Quick abdominal examination to assess contractions and the fetal heart • Bring the delivery trollery on the bed side including resuscitation equipment • Ensure bladder is empty • Cleanse the vulva and vagina • Perform vaginal examination and confirm full dilation of the cervix

MANAGEMENT OF SECOND STAGE conti. . • Explain the procedure to the woman • Assist the woman to be in lithotomy position using stirrups and the buttocks should be on the edge of the bed • Drape the woman • Episiotomy set is ready • Lignocaine 0. 5% amounting to 10 mls in preparation for an episiotomy

BREECH DELIVERY OF FLEXED BREECH

BREECH DELIVERY OF EXTENDED LEGS AND HEAD

3. Breech Extraction • This is a rare procedure done by obstetrician and used in emergency situations e. g. retained twin with foetal distress which presents with breech. • There should be no CPD and the cervix should be fully dilated. • The obstetrician extracts the breech from the birth canal by manipulating the foetus in contrast to the voluntary movements and descent of the foetus produced by uterine contractions when labour is normal.

COMPLICATIONS OF BREECH PRESENTATION First stage of labour • Cord prolapse. • Prolonged 1 st stage of labour. Second stage of labour Impacted breech Birth injury which include: Fracture of humerus, clavicle femur or dislocation of the hip

COMPLICATIONS OF BREECH PRESENTATION CONT’ Fracture of clavicle or dislocation of shoulders Erbs Palsy Damaged adrenal glands Spinal cord damage Intracranial haemorrhage Soft tissue damage Maternal trauma Premature separation of the placenta Foetal hypoxia Stuck head Cord prolapse Cord spasm

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