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BREECH PRESENTATION

BREECH PRESENTATION
Definition :  fetal buttocks is the presenting part
Incidence :  occurs in 3-4% of pregnancies at term (25% before 28 weeks)

Classification

  1. complete: flexion at hips and knees
  2. frank: flexion at hips, extension at knees
    • most common type of breech presentation
    • only breech presentation delivered vaginally
  3. footling: may be single or double with extension at hip(s) and knee(s) so that foot is the presenting part
image

 complete ( flexed )
image
Frank Breech (Extended )

image
Footling Breech
Etiology

Maternal
  1. pelvis (contracted)
  2. uterus (shape abnormalities, intrauterine tumours, fibroids,extrauterine tumours causing compression)
  3. grand multiparity

Fetal
  1. prematurity
  2. multiple gestation
  3. congenital malformations (found in 6% of breeches; 2-3 x the incidence in vertex prese

Maternal-Fetal
  1. placenta (previa)
  2. amniotic fluid (poly/oligohydramnios)
Diagnosis

Leopold maneuvers and U/S



Management

Extenal Cephalic version
  1. criteria: > 37 weeks, singleton, unengaged presenting part,reactive NST
  2. contraindications: previous T3 bleed, prior classical C-section, previous myomectomy, oligohydramnios, PROM,placenta previa, abnormal U/S, suspected IUGR
  3. risks: abruption, cord compression
  4. method: tocolysis, followed by transabdominal manipulation of fetus, guided by ultrasound
  5. if patient Rh negative Rhogam given prior to procedure

Good prognostic factors (for a successful version)
  1. multiparous
  2. good fluid volume
  3. small baby
  4. skilled obstetrician
Criteria for vaginal delivery
  1. frank breech, GA > 36 weeks
  2. EBW 2200-3800 g based on clinical and U/S assessment
  3. fetal head flexed
  4. continuous fetal monitoring
  5. maternal pelvis adequately large (clinically, or ìprovenî by previous delivery)
  6. no other indication for C/S
  7. experienced obstetrician C-section for all other presentations (except mentoanterior face presentation)

BREECH PRESENTATION BREECH PRESENTATION Reviewed by Radiology Madeeasy on January 15, 2011 Rating: 5
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