This document provides information on breech presentation during pregnancy. It defines breech as when a baby is lying bottom or feet first instead of head first. Breech occurs in 3-4% of term pregnancies and up to 25% of preterm pregnancies before 28 weeks. There are three types of breech positions: frank, complete, and footling. Breech can be diagnosed through abdominal palpation, vaginal examination, or ultrasound. Management options include external cephalic version to manually turn the baby, vaginal breech delivery if certain criteria are met, or caesarean section.

1. BREECH PRESENTATION
Dr. Bickey Khadgi

2. Definition
BREECH? Malpresentation is a
presentation that is not cephalic
 The most commonly
encountered malpresentation in
pregnancy is breech
presentation
Breech means that your baby is lying bottom first or feet first
in the womb (uterus) instead of in the usual head first
position. As pregnancy continues, a baby usually turns
naturally into the head first position.

3. INCIDENCE
This presentation occurs in:
1. 3-4% of term pregnancies.
2. 7% of pregnancies at 32 weeks
3. 25% of pregnancies of less than 28 weeks’

4. TYPES OF BREECH
FRANK BREECH
FOOTLING BREECHCOMPLETE BREECH
 Extended or frank breech
 Hips flexed,
 knees extended,
 common in primigravida
 Flexed breech –
 Hips flexed,
 knees flexed,
 Common in multigravida
 Footing breech –
 One or both hips extended,
 foot presenting.
 Cord prolapse is the major
risk.
A BREECH BABY MAY BE LYING IN ONE OF THE
FOLLOWING POSITIONS

5. FRANK
(50-70%)
COMPLETE
(5-10%)
FOOTLING
(10-30%)

6. Causes
MATERNAL
FETAL / PLACENTAL
 Fibroids
 Congenital uterine abnormalities
 Uterine surgery
 Multiple Gestation
 Prematurity
 Placenta praevia
 Abnormality, e.g. anencephaly or hydrocephalus
 Oligohydramnios
 Polyhydramnios

7. DIAGNOSIS
• The diagnosis of breech presentation may be
made by:
1. Abdominal palpation
2. Vaginal examination
3. Confirmed by ultrasound

8. CLINICAL
DIAGNOSI
S
• Palpation
–Fundal grips; the head is felt with its characters.
–Pelvic grip; the breech is felt, with its
characters.
• Auscultation
–The fetal heart sounds are head just at, or
above the level of the umbilicus
ABDOMINAL EXAMINATION

11. VAGINAL EXAMINATION
• Slow dilatation of cervix
• After rupture of the membranes, the presenting part is felt that
is , the two buttocks with the anus in between , the genitalia on
one side and the sacral spines on the opposite side.
• In case of complete breech, the feet are felt on the same level
as the buttocks.
• In case of breech with extended legs, the buttocks only are felt.
• In case of footling presentation, the feet are at a lower level
than the buttocks.

12. Management
ENT
1. EXTERNAL CEPHALIC VERSION
2. Vaginal delivery
3. Lower segment caesarean section (LSCS)

13. MANAGEMENT
1. EXTERNAL CEPHALIC VERSION
 The procedure is performed at or after 37 completed weeks by an
experienced obstetrician.
 ECV should be performed with tocolytics (e.g. nifedipine) as this
has been shown to improve the success rate.
 The woman is laid flat with a left lateral tilt having ensured that
she has emptied her bladder and is comfortable.

15. RISK OF ECV
 Placental abruption
 Premature rupture of membrane (PROM)
 Placental hemorrhage
 Fetal bradycardia

16. VAGINAL BREECH DELIVERY
2 MODE OFDELIVERY

17. INDICATIONS
 Presentation should be either extended or
flexed
 Estimated fetal weight < 3.5 kg
 No evidence of hyperextension of fetal head
and fetal abnormalities (hydrocephalus)

18. TECHNIQUE
1. Delivery of the buttocks
2. Delivery Of the legs and lower body

19. 3. Delivery of shoulders

20. The body of the fetus is then rotated 180 degrees in the
reverse direction to deliver the other shoulder and arm
The trunk is rotated in such a way that the anterior shoulder and arm
appear at the vulva and can easily be released and delivered first.
The appearance of one axilla indicates that its time to
deliver the shoulders
Downward traction until the lower halves of the
scapulas are delivered

21. TECHNIQUE
4. Delivery of THE HEAD
 Delivered using the
Mauriceau- smellie-veit
Manoeuvre
The index and middle finger
of one hand are applied over
the maxilla, to flex the head,
while the fetal body rests on
the palm of the hand and
forearm.

22. Forceps Delivery for after
coming head

23. 3MODE OF DELIVERY
• Lower Segment Caesarean
Section (LSCS)

24. Thank
You