Breech mech of labour

1. Mechanism of labour in breech Amarendra B. Singh 090201263

2. Positions * Left sacro -anterior. * Right sacro -anterior. * Right sacro -posterior. * Left sacro -posterior. * Left and right sacro - transverse (lateral). * Direct sacro -anterior and posterior. Breech - Mech of labour 8/13/2013 2

3. 8/13/2013 Breech - Mech of labour 3

4. Mechanism of labour Delivery of the breech (Buttocks and lower limbs) Delivery of the shoulders and arms Delivery of the head 8/13/2013 Breech - Mech of labour 4

5. Delivery of lower limbs and buttocks Engagement Descent Flexion Internal rotation Birth of Buttocks 8/13/2013 Breech - Mech of labour 5

6. Delivery of the buttocks * The engaging diameter is the bitrochanteric diameter 9.5cm which enters the pelvis in one of the oblique diameters . Breech - Mech of labour 8/13/2013 6

7. The anterior buttock meets the pelvic floor first so it rotates 1/8 circle anteriorly . * The anterior buttock hinges below the symphysis 8/13/2013 Breech - Mech of labour 7

8. and the posterior buttock is delivered first by lateral flexion of the spines followed by the anterior buttock. * External rotation occurs so that the sacrum comes anteriorly. 8/13/2013 Breech - Mech of labour 8

9. Delivery of shoulders and arms Engagement Descent continuous Internal rotation Birth of shoulders Restitution 8/13/2013 Breech - Mech of labour 9

10. Delivery of the shoulders * The shoulders enter the same oblique diameter with the bisacromial diameter 12 cm (between the acromial processes of the scapulae). 8/13/2013 Breech - Mech of labour 10

11. The anterior shoulder meets the pelvic floor first, rotates 1/8 circle anteriorly, hinges under the symphysis , then the posterior shoulder is delivered first, the baby is then lowered and the anterior shoulder and arms pass out under the symphysis . 8/13/2013 Breech - Mech of labour 11

12. Birth of after coming head Engagement Descent Flexion Internal rotation Birth of the head 8/13/2013 Breech - Mech of labour 12

13. Descent and Engagement: The head enters the pelvis in the left oblique diameter. The occiput is in the right anterior quadrant of the pelvis. 8/13/2013 Breech - Mech of labour 13

14. Flexion: It is important that flexion is maintained. Internal rotation: The head strikes the pelvic floor and rotates internally so that sagittal suture comes to lie in anteroposterior diameter . 8/13/2013 Breech - Mech of labour 14

15. Birth of the head by flexion: The nape of the neck pivots under the symphysis and the chin, mouth, nose, forehead, bregma , and occiput are born over the perineum by a movement of flexion. 8/13/2013 Breech - Mech of labour 15