Breech presentation

Commonest malpresentation The lie is longitudinal The podalic pole presents at

the pelvic brim

Varieties

Frank breech Flexed breech Footling presentation

Etiology Prematurity Twins Oligohydramnios Congenital uterine malformations IUD Placenta praevia Hydrocephalus Contracted pelvis Multipara

Diagnosis

P/A head at the upper pole of the uterus.

FHS are heard at a higher level round about the umbilicus

P/V soft and irregular parts are felt

U/S X-ray abdomen

MANAGEMENT OF VAGINAL BREECH DELIVERY

First Stage P/V for the detection of cord

prolapse Pt to be kept in the bed to

preserve membranes Only water is given orally and i/v

fluid to maintain hydration Careful watch for uterine

contractions

SECOND STAGE OF LABOUR

THREE METHODS

SPONTANEOUS 10% Very little assistance other than

support of the baby usually in Multigravida and small

babies ASSISTED BREECH

Delivery is assisted from the beginning to the end this method

should be employed

Breech ExtractionEntire body is extracted

with minimum aid by the mother

Assisted Breech Delivery

STEPS Pt In lithotomy position when

posterior buttock distends the perineum

Episiotomy Pt encouraged to bear down No touch policy is adopted till the

buttocks are delivered with the legs in flexed breech and the trunk slips upto the umblicus

Contd

Extended legs are disengaged Umbilical cord mobilized to minimize

compression Keep the feta back anterior Baby is wrapped Delivery of the arms if extended by

Loveset’s maneuver

Delivery of the after coming head

Forceps delivery Jaw flexion and shoulder traction

(Mauriceau – Smellie – Veit technique)

Third stage of labour

Resuscitation of the baby Third stage

Uneventful Ergometrine is given i/v at

crowning of the head

Indications of caesarean section

Other obstetric reasons of caesarean Poor progress of labour Cord prolapse or cord presentation Appearance of fetal or maternal distress

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