Breech Presentation

Question 1

What are the three types of breech presentation?

Answer 1

Extended (refers to knee position)
Footling - manage with C-section only
Flexed

Question 2

What is the risk associated with footling presentation?

Answer 2

Greatest risk of cord prolapse

Question 3

The following are types of lie (True or False)?
Transverse 
Breech
Cephalic
Longitudinal
Oblique

Answer 3

Transverse - T
Breech - T
Cephalic - F
Longitudinal - T 
Oblique - T

Question 4

What are the risks associated with breech presentation?

Answer 4

Cord prolapse (cord exposure to cold air - vasospasm of the blood vessels)
Difficulty delivering head (head entrapment)
Foetal hypoxia
Increase foetal mortality and morbidity - “Term Breech Trial”

Question 5

Explain what happens before and after external cephalic version

Answer 5

Uterine relaxants given prior to or during procedure - e.g. terbutaline or salbutamol
CTG monitoring used for foetal heart pre and post procedure

Question 6

What are the risks and benefits of ECV

Answer 6

Risks:
Foetal distress (cord entanglement/ retroplacental clot); sometimes transient
Emergency C-section 1:200
Benefits: might prevent C-section or vaginal breech delivery and their associated risks

Question 7

What are the success rates of ECV

Answer 7

Approx 50%
40% in nulliparous
60% in multip

Question 8

What are the contraindications to an ECV?

Answer 8

Under 37 weeks gestations 
Previous C-section
Placenta praevia 
Foetal or uterine abnormality 
Multiple pregnancy