Frank/Extended (65%) Complete/Flexed (25%) Incomplete/Footling (10%) Fibroids or pelvic tumors Uterine Surgery Oligo/Polyhydramnios Uterine anomalies (bicornuate

or septate) Multiple gestation Prematurity Placenta previa Structural anomaly (hydrocephalus, anencephaly) Forceps Method
Performed at 36-37 weeks Done under US guidance Fetal HR trace done before & after Tocolytics may help (ritodrine, salbutamol, nifedipine or GTN) Mauriceau-SmellieVeit maneuver

Types

Breech Presentation
The major factor predisposing to breech presentation is prematurity

Incidence

3% at term

Incidence falls as pregnancy advances

40% at 26 weeks, 25% before 28 w, 20% at 30 weeks

Uterine
Management includes exclusion of fetal and uterine anomalies after 34 weeks

Predisposing factors

Become a problem if baby isnt cephalic by 37 weeks

No controlled trials compare Vag vs c/s, the two small studies that do exist show vaginal safer for mother with increase morbidity for fetus and vice versa.

Complications Cord Prolapse (footling) Difficulty in delivering shoulders Head entrapment (asphyxia)

Fetal
The incidence of structural anomalies is > 6% (2 to 3 times vertex)

Diagnosis

Leopold Maneuver Vaginal Examination Confirmed by US Maternal (5 Ps) Vaginal Delivery

Post (Advanced) age Poor Obstetric history Primigravida

Discouraged

ECV (success )
Only 2% of successful term versions revert o breech Previous cesarean

Unstable Lie
Def: alternating btw trans, oblique, & long.

Pelvis narrow/small

Contraindications Placenta previa Oligo/Polyhydramnios History of APH Previous cesarean Previous uterine surgery Multiple gestation Preeclampsia/HT IUGR Placental abruption PROM Cord prolapse Fetal bradycardia
Transplacental hemorrhage (remember anti-D to Rh ve) Dx: asymmetrical abdomen, symphysis-fundal height less than expected, palpate buttocks or fetal head in iliac fossa, & empty pelvis. Management: Admit and perform cesarean. Gestation less than 36 w Premature breech fetuses are preferentially delivered by cesarean birth because of the head-abdominal size disparity. Risk: Cord prolapsed after SROM, and prolapsed of hand/shoulder/foot in labor

Fetal
Footling presentation Weight < 2.5 kg or > 3.5 kg Extended neck

Complications

Hx: Multiparous woman, lax uterus and abdominal muscles