Breech mech of labour

Mechanism of labour in breech

Amarendra B. Singh090201263

04/12/2023 2

Positions

* Left sacro-anterior. * Right sacro-anterior. * Right sacro-posterior. * Left sacro-posterior. * Left and right sacro- transverse

(lateral). * Direct sacro-anterior and posterior.

Breech - Mech of labour

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Mechanism of labour

• Delivery of the breech (Buttocks and lower limbs)

• Delivery of the shoulders and arms• Delivery of the head

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Delivery of lower limbs and buttocks

• Engagement• Descent• Flexion• Internal rotation• Birth of Buttocks

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Delivery of the buttocks

* The engaging diameter is the bitrochanteric diameter 9.5cm which enters the pelvis in one of the oblique diameters.

Breech - Mech of labour

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The anterior buttock meets the pelvic floor first so it rotates 1/8 circle anteriorly .

* The anterior buttock hinges below the symphysis

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and the posterior buttock is delivered first by lateral flexion of the spines followed by the anterior buttock.

* External rotation occurs so that the sacrum comes anteriorly.

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Delivery of shoulders and arms

• Engagement• Descent continuous• Internal rotation• Birth of shoulders• Restitution

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Delivery of the shoulders

* The shoulders enter the same oblique diameter with the bisacromial diameter 12 cm (between the acromial processes of the scapulae).

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• The anterior shoulder meets the pelvic floor first, rotates 1/8 circle anteriorly, hinges under the symphysis, then the posterior shoulder is delivered first, the baby is then lowered and the anterior shoulder and arms pass out under the symphysis.

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Birth of after coming head

• Engagement• Descent• Flexion• Internal rotation• Birth of the head

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• Descent and Engagement: The head enters the pelvis in the left oblique diameter. The occiput is in the right anterior quadrant of the pelvis.

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• Flexion: It is important that flexion is maintained.

• Internal rotation: The head strikes the pelvic floor and rotates internally so that sagittal suture comes to lie in anteroposterior diameter.

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• Birth of the head by flexion: The nape of the neck pivots under the symphysis and the chin, mouth, nose, forehead, bregma, and occiput are born over the perineum by a movement of flexion.