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Breech Presentation

From Mediwikis

Frank Breech presentation
Flexed Breech
Footlong Breech presentation

Feet or buttocks are the presenting part, rather than the head. It is very common in early pregnancy, and is only a concern is it occurs around term, when it is much rarer as most babies naturally turn.

Types of breech presentation

  • Extended or frank breech (70%) – hips flexed with straight legs so that the feet are up by head, presenting part is buttocks
  • Flexed breech (15%) – knees are flexed so that both buttocks and feet are presenting
  • Footling breech – one knee flexed, the other extended, so that one foot is the presenting part

Causes

  • Idiopathic
  • Difficulty in turning
    • Amniotic fluid – oligohydramnios or polyhydramnios
    • Placental position – placenta praevia
    • Uterine abnormalities – fibroids
    • Multiple pregnancy
  • Preterm delivery
  • Fetal abnormalities

Risk

Fetal:

  • Increase risks of hypoxia and trauma due to cord compression
  • Neck trauma
  • Damage to internal organs due to high pressure on abdomen
  • Cord prolapse
  • Shoulder/arm/leg/hip dislocation, fracture or trauma

Maternal:

  • Prolonged labour/failure to progress

Diagnosis

On examination:

  • Longitudinal lie, head palpable at the fundus
  • Presenting part is not hard
  • Fetal heart heard loudest above the umbilicus

Abdominal USS is needed to confirm the diagnosis

Management

If >36wks:

  • Attempt ECV

If ECV fails or contra indicated:

  • Vaginal breech delivery – will require continuous fetal heart monitoring, and may require instrumentation or C-section if complications arise. Vaginal indication is contraindicated if it is a footling breech, the baby is large, placenta praevia, PMH of C-section, pre-eclampsia.
  • C-section – recommended method of delivery

Can induce labour, but augmentation is not recommended

ECV

External cephalic version – manually rotating the baby from breech presentation to cephalic presentation. Can be quite uncomfortable for the mother, so Tubilene should be given first to soften the uterus. It is offered in uncomplicated singleton breech presentations. It has a 50% success rate. Contraindications:

  • Bleed in the last 7 days
  • Fetal compromise, abnormal fetal monitoring
  • PROM
  • Oligohydramnios
  • Pre eclampsia
  • Bicornuate uterus – heart shaped rather than pear shaped
  • Multiple pregnancy