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Flashcards in Breech Deck (13):
1

Frank breech

Hips are flexed and legs extended

- toes next to face

2

Complete breech

Hips and knees flexed and the feet are not below the level of the fetal buttocks

- sitting crosslegged

3

Footling breech

One or both feet are presenting as the lowest part of the fetus

- extended legs, like standing

4

Associations and causes of breech (maternal factors)

- polyhydramnios/oligohydramnios
- uterine anomalies (bicornuate, septate)
- space occupying lesions (fibroids)
- placental abnormalities (praevia, cornual)
- contracted maternal pelvis
- multiparity (in particular grand multips)

5

Associations and causes of breech (fetal factors)

- prematurity
- fetal anomalies (neurological, hydrocephalus, anenecephaly)
- multiple pregnancy
- fetal death
- short umbilical cord

6

Breech is suspected if...

- abdominal palpation (presenting part is irregular, not ballotable OR head ballotable at fundus of uterus)
- pelvic examination (head not felt in pelvis - buttocks or feet instead)
- very thick meconium present after rupture of membranes
- cord prolapse
- abnormal CTG
- fetal heart heard higher in abdomen

7

Confirm Breech presentation by

Ultrasound scan for diagnosis

- exclude causative factors (polyhydraminos, low lying placenta, fetal anomaly)

8

When do we start worrying about a breech presentation?

No further mx in the uncomplicated pregnancy is required until 37 weeks gestation.

Breech presentation is normal in preterm pregnancy, often times fetus converts to cephalic presentation on their own.

9

Intrapartum care of breech - recommended mode of delivery in emergency?

Emergency Caesarean Section for preterm labour with breech presentation. --> book for 39 weeks gestation if no emergency

unless: vaginal birth imminent OR medical circumstance where survival of fetus unchanged by mode of delivery (24-25wk gestation, lethal condition) OR maternal morbidity of C section judged to be too great for relative potential fetal disadvantages

10

ECV, when is it offered and if unsuccessful what then?

External Cephalic Version

- offered at term (so if brings on labour, baby is ready)
- if unsuccessful elective caesarean section booked for 39 weeks gestation

11

Vaginal breech birth, main complication is:

Cord prolapse.

-lowermost parts of baby not completely filling space of dilated cervix
- when waters break the amniotic sac, umbilical cord could drop down and become compressed
- diminishes oxygen flow to baby (must be delivered immediately)

12

Vaginal birth can only be done in which types of Breech?

Frank or complete breech

- rump of fetus can slow amniotic fluid loss and hence decrease cord prolapse chance

13

Name the 3 classifications of breech

Frank breech
Complete breech
Footling breech