Breech presentation

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1. BREECH DELIVERY Deepa Mishra M. Sc. Nursing (OBG)

2. INTRODUCTION A breech birth is the birth of a baby from a breech presentation, in which the baby exits the pelvis with the buttocks or feet first as opposed to the normal head-first presentation. In breech presentation, fetal heart sounds are heard just above the umbilicus. In a breech presentation, the lie is longitudinal and the podalic pole presents at the pelvic brim. It is the commonest malpresentation .

3. DEFINITION It is a longitudinal lie in which the buttocks is the presenting part with or without the lower limbs. According to Nima Bhaskar A breech birth is the birth of a baby from a breech presentation, in which the baby exits the pelvis with the buttocks or feet first as opposed to the normal head-first presentation. According to Wikipedia

4. INCIDENCE 3-4% of fetus present by breech at term 5% at 34 weeks 20% at 28 weeks 20% diagnosed initially in labour 3.5% term singleton deliveries and about 25% of cases before 30 weeks of gestation undergo spontaneous cephalic version up to term.

5. TYPES

6. Complete Breech (Flexed Breech)

7. 2. Incomplete Breech(30-35%)

8. INCOMPLETE BREECH

9. TYPES OF INCOMPLETE BREECH

10. CLINICAL VARIETIES

11. POSITIONS

12. Etiology Of Breech Presentation

13. DIAGNOSIS

14. CLINICAL   Complete Breech Frank Breech Per Abdomen   Fundal Grip Head- suggested by hard and globular mass Head is ballottable Head Irregular small parts of the feet may be felt by the side of the head. Head is non- ballottable due to splinting action of the legs on the trunk. Lateral Grip Fetal back is to one side and the irregular limbs to the other Irregular parts are less felt on the side

15. CLINICAL   Complete Breech Frank Breech Pelvic Grip F.H.S. Breech- suggested by soft, broad and irregular mass. Breech is usually not engaged during pregnancy Usually located at a higher level round about the umbilicus Small, hard and a conical mass is felt The breech is usually engaged Located at a lower level in the midline due to early engagement of the breech Per Vaginum   During Pregnancy During labour Soft and irregular parts are felt through the fornix   Palpation of ischial tuberosities , sacrum and the feet by the sides of the buttocks The foot felt is identified by the prominence of the heel and lesser mobility of the great toe. Hard feel of the sacrum is felt, often mistaken for the head     Palpation of ischial tuberosities , anal opening and sacrum only

16. Ultrasonography 1 . It confirms the clinical diagnosis- specially in primigravidae with engaged frank breech or with tense abdominal wall and irritable uterus . 2 . It can detect fetal congenital abnormality and also congenital anomalies of the uterus. 3. Type of breech (complete or incomplete). 4. It measures biparietal diameter, gestational age and approximate weight of the fetus. 5 . It also localizes the placenta. 6 . Assessment of liquor volume (important for ECV). 7. Attitude of the head- flexion or hyperextension (Important for decision making at the time of delivery). 8. CT and MRI can be used to assess the pelvic capacity in addition to all the above mentioned information.

17. DURING PREGNANCY

18. DURING LABOUR The 3 bony landmarks of breech namely 2 ischial tuberosities and tip of the scarum . The feet are felt beside the buttocks in complete breech. Fresh meconium may be found on the examining fingers. Male genitalia may be felt.  

19. MECHANISM OF LABOUR

20. Delivery of Buttocks

21. Delivery of Shoulders

22. Delivery of Head

23. PROGNOSIS

24. External Cephalic Version

25. ELECTIVE CAESARIAN SECTION

26. VAGINAL BREECH DELIVERY

27. ASSISTED BREECH DELIVERY

28. ASSISTED BREECH DELIVERY

29. Delayed in Descent of the Breech

30. Extended Arms

31. Arrest of After Coming Head

32. CONCLUSION : The incidence of Breech presentation expected to be low in hospitals where high parity births are minimal and routine external cephalic version done in antenatal period. Breech presentation can be managed by early diagnosis and effective management strategies. By using different maneuvers and skillful observation of the obstetrician.