BREECH

PRESENTATION
Dr. Robinson E. Mbu
Senior Lecturer

DR. R.E. MBU 2006

PLAN

Introduction
Objectives
Clinical types
Aetiology
Evaluation
Indications for C/S
Vaginal delivery
Complications
DR. R.E. MBU 2006

INTRODUCTION

Situation where the baby presents

with the buttocks
3-4% of deliveries are breech
It is more difficult to perform breech
deliveries
Maternal complications are 5X higher
Foetal mortality rate is 8-10X higher
DR. R.E. MBU 2006

CLINICAL TYPES

Frank breech
Complete breech
Incomplete ( footling breech )

DR. R.E. MBU 2006

FRANK BREECH

Flexion at the hip and extension at the knees.

Baby is in form of letter U

DR. R.E. MBU 2006

COMPLETE BREECH

Baby is in sitting position: flexion at the hip

and at the knees.

DR. R.E. MBU 2006

INCOMPLETE BREECH

Breech with single footling

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BREECH WITH
FOOTLING

Single footling

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AETIOLOGY

Prematurity
Uterine relaxation associated with parity
Multiple foetuses
Hydramnios
Oligoamnios
Hydrocephalus
Anencephalus
Previous breech presentation
Uterine anomalies
Tumours
DR. R.E. MBU 2006

CLINICAL EVALUATION

Leopolds maneuver
First maneuver
Foetal head at the fundus

Third maneuver
Breech at the brim

Vaginal examination
Breech palpable

Ultrasonography
Confirms breech presentation
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FOETAL COMPLICATIONS

Prematurity
Malformations 2-3X higher
Birth trauma
Low Apgar score
Mortality 8-10X higher at every stage
of gestation:

Ante partum
Intra partum
Post partum
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FOETAL COMPLICATIONS contd

Foetal traumatic vaginal deliveries

involving in order of frequency:

The brain
Spinal cord
Liver
Adrenal glands
The spleen
Brachial plexus
The pharynx
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MATERNAL COMPLICATIONS

Higher maternal morbidity from

greater frequency of operative
deliveries
Higher maternal mortality from the
same cause
However, labour is not prolonged
About 9 hrs. for the nullipara
About 6 hrs. for the multipara
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INDICATIONS FOR C/S IN

BREECH

Breech with baby weighing > 3.5kg.

Breech with borderline , contracted , or
any unfavourable shape of the pelvis
Breech and a hyperextended head
Breech and uterine dysfunction
Footling breech
Breech and severe IUGR
Breech with PIH , prolonged PROM
Breech with previous perinatal death
Breech with a history of birth trauma
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CONDITONS FOR VAGINAL DELIVERY

IN BREECH

Frank breech
Adequate pelvis
Foetus judged to weigh less than
3.5kg
Labour is spontaneous and effective(
effacement, dilatation, descent )
Qualified and experienced personnel
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TECHNIQUE OF VAGINAL
DELIVERY

Allow the breech to come out up to the

level of the umbilicus
Flex the knees individually and deliver
the legs
Hold the foetus by the waist with both
hands and pull until you see the
shoulders
Rotate the foetus 90 degrees and bring
the first arm anteriorly and deliver it
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TECHNIQUES OF VAGINAL DELIVERY

contd

Replace the foetus to the ventral

position
Rotate the foetus again at 90
degrees to bring the opposite hand
anteriorly and deliver it
Deliver the by either :
Maurison-Smelie-Veit maneuver
Or by forceps
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