Breech presentation

Question 1

Types of breech presentation

Answer 1

• Frank / Extended (70%)
  
  • Flexed at the hips, extended at the knees
• Complete / Flexed (15%)
  
  • Hips and knees both flexed
• Incomplete / Footling (15%) - most concerning
  
  • One leg flexed, one leg extended

Question 2

Risk factors for breech presentation

Answer 2

• Conditions that allow more room to turn
  
  • Polyhydramnios
  • High parity (lax uterus)
• Conditions that prevent turning
  
  • Multiple pregnancy
  • Uterine abnormalities
  • Foetal abnormalities (hydrocephalus)
• Conditions that prevent engagement
  
  • Placenta praevia
  • Pelvic tumours
  • Uterine abnormalities
• Premature labour (breech more common in early pregnancy)
• Previous breech delivery

Question 3

Diagnosis of breech presentation

Answer 3

*Only improtant from 37 weeks*

• Subcostal tenderness
• Ballotable head in the fundus
• Foetal heartbeat loudest above the umbilicus

Diagnosis via ultrasound

• Also helps to detect potential cause:
  
  • Foetal abnormality
  • Placenta praevia
  • Pelvic tumour

Question 4

Complications of breech presentation

Answer 4

• Cord prolapse
  
  • Cord delivers first, baby descends and blocks foetal blood supply
• Head may get stuck (since extended / too big) → mortality
• Caesarean section

Question 5

Management of breech pressentation

Answer 5

• External cephalic version (ECV)
  
  • From 37 weeks
  • Uterine relaxant (tocolytic) administered
  • Forward somersault under US guidance
  • CTG performed afterwards
  • Anti-D given to Rh -ve women
• Complications
  
  • Placental abruption
  • Uterine rupture
• Contraindications
  
  • Foetal compromise (abnormal CTG)
  • Vaginal delivery contraindicated (placenta praevia)
  • Recent APH
  • Ruptured membranes

Caesarean if ECV contraindicated or fails