24-breech.ppt breech presentation mechanism

OBSTETRICS

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

2. 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

3. 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.
PerinatalMortality 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.

4. 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

5. 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
Rhimmune globulin to prevent
isoimmunization

6. 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

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

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

9. 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

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