Breech presentation



Commonest malpresentation
The lie is longitudinal
The podalic pole presents at the
pelvic brim
Varieties



Frank breech
Flexed breech
Footling presentation
Etiology









Prematurity
Twins
Oligohydramnios
Congenital uterine malformations
IUD
Placenta praevia
Hydrocephalus
Contracted pelvis
Multipara
Diagnosis





P/A head at the upper pole of the
uterus.
FHS are heard at a higher level round
about the umbilicus
P/V soft and irregular parts are felt
U/S
X-ray abdomen
MANAGEMENT OF VAGINAL
BREECH DELIVERY

First Stage




P/V for the detection of cord prolapse
Pt to be kept in the bed to preserve
membranes
Only water is given orally and i/v
fluid
to maintain hydration
Careful watch for uterine contractions
SECOND STAGE OF LABOUR
THREE METHODS


SPONTANEOUS 10%
Very little assistance other than
support of the baby usually in
Multigravida and small
babies
ASSISTED BREECH
Delivery is assisted from the
beginning to the end this
method
should be employed

Breech Extraction
Entire body is extracted with
minimum aid by the mother
Assisted Breech Delivery

STEPS




Pt In lithotomy position when posterior
buttock distends the perineum
Episiotomy
Pt encouraged to bear down
No touch policy is adopted till the
buttocks are delivered with the legs in
flexed breech and the trunk slips
upto the umblicus
Contd





Extended legs are disengaged
Umbilical cord mobilized to minimize
compression
Keep the feta back anterior
Baby is wrapped
Delivery of the arms if extended by
Loveset’s maneuver
Delivery of the after coming
head


Forceps delivery
Jaw flexion and shoulder traction
(Mauriceau – Smellie – Veit technique)
Third


stage of labour
Resuscitation of the baby
Third stage
Uneventful
 Ergometrine
is given i/v at
crowning of the head

Indications of caesarean
section




Other obstetric reasons of caesarean
Poor progress of labour
Cord prolapse or cord presentation
Appearance of fetal or maternal distress
Thank You