DR RAZAQ O MASHA FRCOG Consultant ObGyn Dept

DR. RAZAQ O. MASHA, FRCOG Consultant, Ob/Gyn Dept.

Breech presentation occurs in 3 -4% of all deliveries. The percentage of breech deliveries decreases with advancing gestational age from 25% of births prior to 28 weeks gestation to 7% of births at 32 weeks gestation to 1 -3% of births at term

PREDISPOSING FACTORS Prematurity Uterine malformations or fibroids Placenta praevia Fetal abnormalities, (e. g. CNS malformations, neck masses) Multiple gestations Fetal abnormalities are observed in 17% of preterm breech deliveries and 9% of term breech deliveries. Perinatal Mortality is increased 2 -4 fold with breech presentation, regardless of the mode of delivery. Deaths are most often associated with malformations, prematurity and intrauterine fetal demise.

TYPES OF BREECHES: Frank breech (50 -70%) – Hips flexed, knees extended Complete breech (5 -10%) – Hips flexed, knees flexed Footling or incomplete (10 -30%) One or both hips extended, foot presenting

EXTERNAL CEPHALIC VERSION (ECV) This is the trans-abdominal manual rotation of the fetus into a cephalic presentation. Improved outcome may be related to the use of non stress tests both before and after ECV Improved selection of low-risk fetuses Rh immune globulin to prevent isoimmunization

PROCEDURE: Prepare for the possibility of caesarean delivery. Perform a non-stress test – to confirm fetal well being. Perform the ECV, in or near a delivery suite After ECV, repeat the non-stress test. Administer Rh immune globulin to women who are Rh- negative

RISKS: Precipitation of labour or premature rupture of membranes Abruptio placentae Feto-maternal haemorrhage Cord entanglement Fractured fetal bones

CONTRAINDICATIONS: Multiple gestations Contra indications to vaginal delivery (e. g. herpes simplex virus infection, placenta praevia) Non reassuring fetal heart rate tracing

VAGINAL BREECH DELIVERY The three types of vaginal breech deliveries are described: Spontaneous breech delivery. No traction or manipulation of the infant is used. This occurs predominantly in very preterm deliveries. Assisted breech delivery: The most common type of vaginal breech delivery. Total breech extraction. Use for a non cephalic second twin and caesarean deliveries

RISKS: ♣ Lower apgar scores ♣ Fetal head entrapment ♣ Cervical spine injury ♣ Cord prolapse