Breech Presentation

PENNY LYNE JALIUS GROUP 4 4TH YEAR 1ST SEMESTER 2011

WHAT IS BREECH?
When the buttocks of the fetus enter the pelvis before the head, the presentation is breech.

ASSOCIATED FACTOR
Hydroamnios High parity with uterine relaxation Multiple fetuses Hydroencephaly Previous breech delivery Pelvic tumor

TYPES OF BREECH PRESENTATION

Frank breech - the lower extremities are flexed at the hips and extended at the knees, and thus the feet lie in close proximity to the head Complete breech -one or both knees are flexed

 Incomplete breech -one or both hips are not flexed, and one or both feet or knees lie below the breech, such that a foot or knee is lowermost in the birth canal Footling breech - an incomplete breech with one or both feet below the breech.

Frank breech

Complete breech

Incomplete breech

Delivery
1.Spontaneous breech delivery. The fetus is expelled entirely spontaneously without any traction or manipulation other than support of the newborn. 2. Partial breech extraction. The fetus is delivered spontaneously as far as the umbilicus, but the remainder of the body is extracted or delivered with operator traction and assisted maneuvers, with or without maternal expulsive efforts. 3. Total breech extraction. The entire body of the fetus is extracted by the obstetrician.

Management (Antenatal)
The position of breech presentation can be corrected by using Leopold Maneuver It can be done from 34 weeks gestation.

 But complication may occur such as: - The placenta might be partly separated - There may be unsuspected complication such as an abnormal uterus or short umbilical cord. - Excessive force may cause rupture of the uterus

Contra-indication: Pre-eclampsia Previous scar on the uterus Multiple pregnancy fetal abnormality

Video