Breech presentation (Complete)

Question 1

Define breech presentation

Answer 1

Positioning of the foetus in a longitudinal lie with head proximal to the fundus and feet/buttocks proximal to the cervix

Question 2

Breech presentation occurs in what percentage of pregnancies?

Answer 2

3-4%

Question 3

What maternal risk factors are associated with breech presentation?

Answer 3

Anatomical abnormalities:

Uterine abnormalities

• Fibroids
• Septate uterus

Pelvic abnormalities

• contracted or abnormally shaped pelvis

Amniotic fluid complications:

• Oligohydraminos
• Polyhydraminos

Obsteric history:

• Previous breech pregnancy
• Family history of breech pregnancy
• First pregnancy
• Grand multiparity (e.g. >5)

Advanced maternal age

Question 4

What foetal factors are associated with increased risk of breech presentation?

Answer 4

Prematurity

IUGR

Genetic abnormalities

Hydrocephalus

Ancephaly

Twin pregnancy

Short umbillical cord

Nuchal umbillical chord

Question 5

What is the primary sign of breech presentation?

Answer 5

Buttocks or feet proximal to the cervix

Broader, softer, less defined presenting part (suggestive of foetal bottom or legs)

Question 6

What investigation will confirm the diagnosis of breech presentation?

Answer 6

Ultrasound

Question 7

How are patients with breech presentation managed?

Answer 7

If < 36 weeks: Observation only (many breech presentations will resolve)

If > 36 weeks:

1) Offer extra cephalic version (ECV)

• 60% success rate

2) Elective C-section: If ECV unsuccessful

Question 8

What is ECV?

Answer 8

Manual procedure where an experienced physician attempts to turn the baby to guide the foetus into a head-down position

Question 9

What is given to the mother during an ECV procedure

Answer 9

Sedatives

Tocolytics

Anti-D immunoglobulins (if rhesus negative)

Question 10

What are absolute contraindictions to ECV?

Answer 10

Caesarean section is already indicated for other reason

Antepartum haemorrhage in the last 7 days

Abnormal cardiotocograph

Major uterine abnormality

Placental abruption or placenta praevia

Ruptre of membranes

Multiple pregnancy (but may be considered for delivery of the second twin)

Question 11

What complications can occur due to ECV?

Answer 11

Transient fetal heart rate changes

Placental abruption

Preterm labour

Premature rupture of membranes

Umbilical cord entanglement and compression

Foetal trauma

Question 12

What foetal complications can occur in vaginal delivery with breech presentation?

Answer 12

Head entrapment

• Particularly in preterm infants

Birth asphyxia

• Due to compression of umbillical chord during delivery

Prolapsed umbilical chord

Hypoxic ischaemic encephalopathy

Traumatic injury

• Clavicle/humerus fracture
• Brachial plexus injury

Question 13

What maternal complications can occur in vaginal delivery with breech presentation?

Answer 13

Prolonged Labor

Birth Traum

• Perineal tears
• Episiotomy

Heamorrhage

• Uterine rupture
• Atonic postpartum haemorrhage