This document discusses the diagnosis and management of breech presentations and breech births. It notes that breech presentations occur in 3-4% of term births. Risk factors include primigravidity, uterine anomalies, and fetal anomalies. For a vaginal breech birth, the cervix must be fully dilated and the fetal anus visible. The breech should be allowed to descend spontaneously and maneuvers like Lovset's may be needed to deliver the arms. The Mauriceau-Smellie-Veit maneuver is then used to slowly deliver the head. Complications may require emergency cesarean section.

1. Breech
Presentation
Lucy Pettit

2. Aims and Objectives
 At the end of the session, we should be
able to: -
 Diagnose a breech presentation
 Carry out a breech delivery
 Be familiar with the manoeuvres if
assistance is required

3. Incidence
 3-4% of fetus present by breech at term
 7% at 32 weeks
 25% at 28 weeks
 20% diagnosed initially in labour

4. Causes / Risk Factors
 Primigravida
 Uterine anomalies
 Uterine fibroids
 Pelvic anatomy
 Fetal anomalies
 Multiple pregnancy
 Preterm labour
 Oligohydraminos / polyhydramnios
 Grand multiparity
 Fetal death

5. External Cephalic Version
 Best evidence states that E C V should be
offered late in pregnancy
 Success rate increased with:
 multiparity
 adequate liquor
 station of breech above the pelvic brim

6. Diagnosing a Breech
 Palpation:
 The fetal head can be palpated at uterine
fundus
 Auscultation:
 The fetal heart sounds may be heard above
umbilicus

7. Types of Breech
Frank Complete Footling

8. Vaginal Examination
 extended (frank) presentation:
 The ischial tuberosities, sacrum anus and/or
genitals may be palpated. In addition, there
may be meconium staining of the examiner’s
fingers
 complete presentation:
 The feet of the fetus may be palpated with the
buttocks

9. Emergency Care
 Call for help – midwifery colleagues/8000
 Support & explanations for parents
 Take blood for group/hold, FBC
 Monitor fetal heart
 Monitor maternal vital signs
 Prepare IV Normal Saline – cannulation 16g
 Transfer to theatre – if not 
 Prepare for vaginal delivery

10. Vaginal Breech Birth in Hospital
 Explain procedure to patient
 Legs in lithotomy
 Empty bladder
 Confirm full dilatation/presentation/station
 Infiltrate perineum with 10mls Lignocaine1%
 Consider episiotomy when presenting part is
on the perineum
 Perform necessary manoeuvres for the
delivery of breech
 Record times of procedures / manoeuvres,
designate a scribe

11. Breech Delivery
The essence of the vaginal breech delivery is allowing as
much spontaneous delivery by uterine action and
maternal effort as possible
Operator intervention should be limited to the
manoeuvres.
Nuchal arms are present in 0-5% of vaginal breech
deliveries and in 9% of breech extractions.

12. Breech Delivery
The cervix should be
fully dilated and the
fetal anus visible on
the perineum for
active second stage.

13. Breech Delivery
The woman should
be in lithotomy
position.

14. Breech Delivery
Delivery of the
breech should be
‘hands off’
Legs and abdomen
are born
spontaneously.

15. Breech Delivery
Ensure that the fetal
back rotates
uppermost by
carefully grasping
the fetal pelvis with
fingers & thumbs

16. Breech Delivery
The fetus should be
allowed to hang
once the legs and
abdomen have
emerged until the
wings of the scapula
are seen.

17. Lovset’s Manoeuvre
Grasp the fetus around the
bony pelvis with the
thumbs across the
sacrum.
The fetal back should then
be turned through 180
degrees until the
posterior arm comes to
lie anteriorly…….

18. Lovset’s Manoeuvre
The elbow will appear below
the symphysis pubis and
the arm is delivered by
sweeping it across the
fetal body.
The manoeuvre is repeated
in reverse to deliver the
other arm.

19. Breech Delivery
Allow the fetus to hang
from the vulva until
the nape of the neck
is visible.
Then carry out
Mauriceau-Smellie-
Veit manoeuvre

20. Emergency Checklist
Em ergency Check list
Vaginal Br eech Deliver y Bradma
Procedure Dat e ________________ Tim es Names of
pract it ioner s
• Emergency Bell ……………. pr esent
• 8000 obstetric emergency call made/ Paediatrician called …………….
• Notify theatre of potential emergency LSCS …………….
• Delivery trolley with Wrigley/NB forceps …………….
• Commence CTG tracing …………….
• IV cannula inserted …………….
• Mother in left lateral or lithotomy …………….
• Maternal pushing when fully ……………
• Descent of fetus ‘hands off’ …………….
• Evaluate for episiotomy when fetal anus at fourchette …………….
• Deliver legs if extended by flexing the fetal knees …………….
• Rotate to keep back anterior …………….
• Any contact with fetus only with hands on fetal pelvis (avoid
soft abdomen) ……………..
• When scapulae visible spontaneous delivery of arms ……………..
• Lovset’s manoeuvre (if necessary) ……………..
• Support trunk (fetus along dorsal aspect practitioner arm) ……………..
• Burns-Marshall or Mauriceau-Smellie-Veit manoeuvre to
deliver head slowly …………….
• Delivery time …………….
• Cord blood sample for Ph/lactate …………….
• Third stage by active management ……………..
• Documentation ……………..
Photocopy this checklist and place in patient’s notes with patient label on top of page. Use as
reference for more detailed clinical notes. Remember to sign the copy for the clinical notes.
Please wipe clean checklist once copied and return to delivery room