The document outlines the management of breech delivery, distinguishing between spontaneous, assisted, and total breech extraction methods. It details procedures, indications for vaginal delivery, the use of scoring systems to assess delivery options, and maneuvers for overcoming complications during breech delivery. Additionally, it includes specific techniques for delivery of the fetus in various presentations, including frank breech and nuchal arms.

1. ASSISTED BREECH
DELIVERY
By Assistant Professor Dr. Kavitha M MS OBG

2. • With a cephalic presentation, once the head is delivered,
the rest of the body typically follows without difficulty.
• With breech, however, successively larger and less
compressible parts are born last.
• Spontaneous complete expulsion of fetus that presents
as breech is seldom accomplished successfully.

3. MANAGEMENT OF DELIVERY OF BREECH PRESENTATION

4. • VAGINAL DELIVERY
1. Spontaneous breech delivery : The entire infant is
expelled by natural forces of the mother with no assistance
other than support of the baby as it is born
2. Assisted breech delivery : The fetus is delivered
spontaneously as far as the umbilicus, but the remainder of
the body is delivered with assisted maneuvers, with or
without maternal expulsive efforts.
3. Total breech extraction :the entire body of the infant is
extracted by the obstetrician
• CAESEREAN SECTION

5. ZATUCHINI-ANDROS PROGNOSTIC
SCORING(1967)
• Most popular scoring system for assessing the
prognosis of successful vaginal delivery.

6. 0 1 2
PARITY primi multigravida
GESTATIONAL
AGE
>39
weeks
38weeks 37 weeks
ESTIMATED
FETAL WEIGHT
>3.5kg 3-3.5kg <3kg
PREVIOUS
BREECH
DELIVERY >2500g
none 1 >2
CERVICAL
DILATATION
<2cm 3cm > 4cm
STATION OF
BREECH
> - 3 -2 < -1

7. • Score 3 or less : CESAREAN SECTION
• Women with higher scores can be allowed for
VAGINAL DELIVERY.

8. INDICATIONS FOR VAGINAL DELIVERY
Frank or complete
breech
presentation
Gestational age >36
weeks
Estimated fetal
weight 2.5 to
3.5kg
Fetal head
must be
flexed
Adequate
maternal pelvis.
No other
obstetric
complications
Good ZA score

9. MANAGEMENT OF FIRST STAGE OF LABOUR

10. ⮚An iv line is started preferably with
ringer lactate.
⮚Vaginal examination is indicated
- at the onset of labour for pelvic assessment
- soon after rupture of membrane to exclude cord
prolapse
⮚Blood is sent for grouping and matching
⮚ Patient with term breech presentation is
advised to stay in bed. (to prevent PROM)

11. Adequate
analgesia is
given ,
epidural is
preferred.
Fetal heart
rate
monitored
by CTG.
Monitoring
progress of
labour by
PARTOGRA
M
Oxytocin
infusion
may be used
for the
augmentatio
n of labour.

12. MANAGEMENT OF SECOND STAGE OF
LABOUR

13. Spontaneous breech delivery
Assisted breech delivery
Total breech extraction

14. ASSISTED BREECH DELIVERY
• Ideally, the breech is allowed to deliver spontaneously upto the
umbilicus.
• This is the most common mode of vaginal breech delivery.
• This is a “HANDS OFF TECHNIQUE”.
• MASTER INACTIVITY
• WATCHFUL EXPECTENCY
• Certain manoeuvres are initiated by the obstetrician to aid
delivery of the remainder of body , arms and head.

15. PREREQUISITES
1. The back should always be anterior
2. Fetus should not be pulled from
below.
3. Baby’s body covered by sterile towel
–prevents premature attempt of
inspiration due to external cutaneous
stimuli
4. Fetus head should always be
maintained in flexion.

16. ASSISTED BREECH DELIVERY STEPS
Wait for the legs to deliver spontaneously. (or hook out
the legs)
With increasing uterine contractions the breech emerges
out of the vulval outlet.
Local infiltration anaesthesia is given and mediolateral
episiotomy is done.
After the decent of the breech into the pelvic floor, once
climbing of perineum takes place

17. FEMORAL PELVIC GRIP : bony pelvis is
grasped with both hands using a warm
towel.
Fingers on the anterior superior iliac
spine
Thumb on the sacrum.
Maternal expulsion efforts.
Steady, gentle downward traction is
applied until the lower halves of the
scapula are delivered.
Appearance of one axilla indicates the
time for shoulder delivery.

18. DELIVERY OF THE SHOULDER
Attempt is made for the delivery of the shoulder when one
axilla is seen at the pubic symphysis.
Ordinarily, the arm being flexed at the elbow the shoulders
deliver without much difficulty.
Posterior arm is delivered first followed by anterior
arm.

19. DELIVERY OF THE HEAD
• After the shoulders are delivered.
• The back of the fetus is in the direction of
the symphysis which is followed by the
assisted delivery of the head.
• Hairline is seen under the symphysis.

20. • MARSHALL BURNS TECHNIQUE
• MODIFIED MAURICEAU SMELLIE VEIT
PROCEDURE
• FORCEP’S DELIVERY

21. MARSHALL BURNS TECHNIQUE
The baby is allowed to
hang by its own
weight.
Suprapubic pressure is given
in the downward and
backward direction.
KRISTELLAR MANUEVRE

22. When nape of the neck
is visible under the
pubic arch, the baby is
grasped by the ankle
with a finger between
the two.
Maintaining traction
the trunk is swung in
upward and forward
direction.
The other hand to
guard the
perineum.

23. MODIFIED MAURICEAU SMELLIE VEIT
PROCEDURE

24. Suprapubic pressure is applied
simultaneously which also helps keep the
head flexed.
Two fingers of the other hand then are
hooked over the fetal neck , and grasping
the shoulder downward traction is applied
concurrently until the subocciput region
appears under symphysis.
The index and middle finger of one hand is
applied over the maxilla to flex the head
while the fetal body rests on the hand and
forearm.
Delivery of the head via flexion

25. MAURICEAU
SMELLIE VEIT
MANEUVER
suprapubic pressure by
one obstetrician on the
mother’s uterus
while another obstetrician
inserts left hand in vagina,
placing 2 fingers on the
malar prominences and
another finger in the fetus
mouth
This maneuver is named after FRANCOIS
MAURICEAU, WILLIAM SMELLIE,GUSTAV
VEIT.

26. The left hand's palm
should rest against the
fetus' chest,
the right hand can grab
either shoulder of the fetus
and pull in the direction of
the fetus' pelvis.

27. FORCEPS DELIVERY
PIPER’S FORCEPS

28. Fetal body is elevated using a warm
towel .
Left blade of the forceps is applied to
the aftercoming head.
Right blade is applied with the body
still elevated.
Locking the blades. Application of
traction with the obstetrician is
kneeling down position.
The fetus head is delivered by pulling
gently outwards and raising the
handles simultaneously.

30. MANAGEMENT OF COMPLICATED BREECH
DELIVERY

31. • FRANK BREECH
• EXTENDED ARMS
• NUCHAL ARMS
• OCCIPITOPOSTERIOR POSITION OF HEAD

32. FRANK
BREECH

33. PINARD’S MANUEVER
One hand is introduced
into the vagina, fingers
are guided along the
posterior aspect of the
knee.

34. Gentle pressure is
exerted in the
popliteal space.
This causes the
leg to flex at the
knee.
The foot is
grasped and
brought down to
the vulva

35. EXTENDED
ARMS
LOVSETT
MANEUVER

36. LOVSET
MANEUVER
I. The trunk is rotated so that
the anterior shoulder and
arm appear at the vulva
and a finger is passed
along the arm down to the
elbow which is flexed and
the hands drop down.

37. I. Then the body is
rotated 180
degree in the
reverse direction
to deliver other
shoulder and arm.

38. NUCHAL ARMS
Nuchal arms denotes that the hand is
behind the occiput. One or both hands
may be in this position. (flexed at the
elbow and extended at the head)
Incidence : 0-5% of vaginal breech
deliveries
The diagnosis is made when the
obstetrician notices that the medial
border of the scapula is not parallel to

39. After grasping the baby at pelvic girdle with
thumbs on sacrum
Rotated 180 degree towards the fingertips of
trapped arm
Lovset maneuver

40. OCCIPITOPOSTERIOR POSITION OF HEAD

41. MODIFIED PRAQUE MANEUVER
In rare cases the fetus fails to rotate
anterior, in such cases the fetus maybe
delivered by this method.
Two fingers of one hand grasping the
shoulders back down fetus from
below.
Other hand draws the feet up and over
the maternal abdomen.

42. TOTAL BREECH EXTRACTION
• INDICATIONS
1. NONCEPHALIC
PRESENTATION OF THE
SECOND TWIN ONCE THE
FIRST TWIN HAS
DELIVERED.
2. FETAL DISTRESS
3. CORD PROLAPSE

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