breech-presentation.ppt
- 2. Definition The definition of breech presentation is when the buttocks, foot or feet are presenting instead of the head. It is a longitudinal lie in which the buttocks is the presenting part with or with the lower limbs.
- 3. Incidence • Single Pregnancy - 3.5%
- 4. Types 1. Complete Breech – 25 – 30% – Both knees and hips are flexed – More common in Multipara 2. Incomplete Breech - 30 – 35%,Buttocks – 70% a) Frank Breech b) Footling Presentation c) Knee presentation
- 7. Frank breech: Breech with extended legs More common in primi gravida Footling presentation: Longitudinal lie Hip and knee joints are extended on one or both sides More common in preterm singleton breeches
- 8. Knee presentation • Hips is partially extended and the knee is flexed on one or both sides
- 9. What are the causes?
- 10. Maternal factors • Polyhydraminos • Uterine anomalies (bicornuate, septate) • Space occupying lesions (e.g fibroids) • Placental abnormalities (praevia, cornual) • Multiparity (in particular grand multips)
- 11. Fetal factors • Prematurity • Fetal anomalies (e.g neurological, hydrocephalus, anenecephaly) • Multiple pregnancy • Fetal death • Short umbilical cord
- 13. Diagnosis During Pregnancy • Inspection : – transverse groove may be seen above the umbilicus • Palpation: – Fundus – Head – Pelvic grip – buttocks • Auscultation: – Above the level of umbilicus – Frank breech – below the umbilicus USG
- 14. During Labour : Vaginal Examination – Fresh meconium to be found on the examination fingers – Male genetalia may be felt
- 16. Management should be assessed carefully before selection for vaginal breech birth
- 17. • External Cephalic version • Caesarean Section • Vaginal Delivery
- 18. unfavourable for vaginal breech birth ● other contraindications to vaginal birth (e.g. placenta praevia, compromised fetal condition) ● clinically inadequate pelvis ● footling or kneeling breech presentation ● large baby (usually defined as larger than 3800 g) ● growth-restricted baby ● Hyperextended fetal neck in labour (diagnosed with ultrasound or X-ray where ultrasound is not available) ● lack of presence of a clinician trained in vaginal breech delivery ● previous caesarean section.
- 19. Intrapartum management • should take place in a hospital with facilities for emergency caesarean section • Labour induction for breech presentation may be considered if individual circumstances are favourable • Labour augmentation is not recommended
- 20. • Epidural analgesia should not be routinely advised; women should have a choice of analgesia during breech labour and birth.
- 21. • Continuous electronic fetal heart rate monitoring should be offered to women with a breech presentation in labour. • Caesarean section should be considered if there is delay in the descent of the breech at any stage in the second stage of labour. • Episiotomy should be performed when indicated to facilitate delivery
- 22. Three types of vaginal breech deliveries Spontaneous breech delivery Assisted breech delivery Total breech extraction
- 23. Total breech extraction • only with 2nd non vextex twin delivery • procedure in which the infant's feet are grasped by the operator and the fetus is extracted from the uterine cavity through the vagina.
- 24. ECV • External cephalic version (ECV) is the trans abdominal manual rotation of the fetus into a cephalic presentation. • after ECV successful rate 35-86% • breech presentation at term, after ECV 1 - 1.5%
- 26. contraindication to ECV • preterm • Multiple pregnancy • significant third trimester bleeding • IUGR, • oligohydramnion • PROM • PIH • nonreassuring foetal monitoring patterns • all contraindications to vaginal birth are concerned to execute ECV
- 27. Risk of ECV • umbilical cord entanglement • abruptio placenta • premature rupture of the membranes (PROM) • severe maternal discomfort
- 28. Vaginal Breech Delivery 1. Spontaneous Breech delivery 2. Assisted Breech Delivery Delivery of the buttocks Delivery of the shoulders Delivery of the after coming head
- 29. Delivery of the head • Jaw flexion – Shoulder traction (Mauricean – Smellie Veit ) Method
- 32. Complicated Breech Delivery 1. Arrest of the buttocks at the pelvic brim : – Breech extraction – C.Section 2. Arrest of the buttocks at the pelvic outlet – Breech extraction – C.Section – Episiotomy
- 33. Groin Traction • Pinard’s Method(Popliteal fossa)
- 34. Arrest of the shoulders • Lovset Manoeuvre
- 35. THANK YOU