Breech presentation

types of breech
how you can manage a woman with breech baby?
what is External cephalic version and who can do it ?
what is the risks of vaginal breech birth ?

1. Breech presentation Noor H. Sadiq Wasit university/college of medicine Iraq 10-10-2016

2. objectives

3. INCIDENCE 3-4% of fetus present by breech at term 5% at 34 weeks 20% at 28 weeks 25% of cases before 30 weeks of gestation undergo spontaneous cephalic version up to term.

4. Types Frank breech where the hips are flexed and legs extended Complete breech where the hips and knees are flexed and the feet are not below the level of the fetal buttocks Footling breech where one or both feet are presenting as the lowest part of the fetus

5. Risk factors

6. Diagnosos

7. DURING PREGNANCY

8. Management If diagnosed before 34 weeks in multiparous and 32 weeks in nulliparous, no need to do anything because there is a good chance for spontaneous version to cephalic . If diagnosed after 34 weeks or 32 weeks in nulliparous then external cephalic version .

9. External cephalic version

10. Contraindications to ECV Fetal abnormality (e.g. hydrocephalus) Placenta praevia Oligohydramnios or polyhydramnios History of antepartum haemorrhage Previous Caesarean or myomectomy scar on the uterus Multiple gestation Pre- eclampsia or hypertension Plan to deliver by Caesarean section anyway

11. Risks of ECV Placental abruption Premature rupture of the membranes Cord accident Transplacental haemorrhage Fetal bradycardia

12. Management of persistent breech reassess the patient for any medical or obstetrical problems like; PET, bad obstetrical history, diabetes or Rh isoimmunisation .. etc. ; if any abnormality present then CS is indicated .also if footling breech then CS is indicated . study for fetopelvic disproportion; Clinical pelvimetry + fetal weight estimation by: US X- ray pelvimetry ; With only single exposure – lateral erect position .. Any pelvic abnormality or if the head is extended then CS . CT scan can give better result , but more x-ray exposure . if after reassessment everything is normal and CS is not necessary then vaginal delivery of breech may be allowed.

13. Prerequisites for vaginal breech delivery Feto -maternal: • The presentation should be either extended (hips flexed , knees extended) or flexed ( hips flexed , knees flexed but feet not below the fetal buttocks ). • There should be no evidence of feto -pelvic disproportion with a pelvis clinically thought to be adequate and an estimated fetal weight of 3500 g (ultrasound or clinical measurement). • There should be no evidence of hyperextension of the fetal head, and fetal abnormalities that would preclude safe vaginal delivery (e.g. severe hydrocephalus ) should be excluded.

14. MECHANISM OF LABOUR

15. Risks of vaginal breech birth ● other contraindications to vaginal birth (e.g. placenta praevia , compromised fetal condition) ● clinically inadequate pelvis ● footling or kneeling breech presentation ● large baby (usually defined as larger than 3800 g) ● growth-restricted baby (usually defined as smaller than 2000 g) ● Hyperextended fetal neck in labour (diagnosed with ultrasound or X-ray where ultrasound is not available) ● lack of presence of a clinician trained in vaginal breech delivery ● previous caesarean section.

16. prognosis

17. THANK YOU ‘source; The Ten Teachers obstetric