This document discusses breech presentation during childbirth. It defines breech presentation as when the fetus is positioned longitudinally with the buttocks or feet facing the birth canal. It classifies breech presentations as complete breech, incomplete breech (frank breech or footling), or knee presentation. Common causes of breech presentation include prematurity, factors preventing fetal version, and fetal abnormalities. Breech presentation is diagnosed through clinical examination including abdominal and vaginal palpation as well as ultrasound. The mechanism of labor in breech presentation and management options like external cephalic version, vaginal delivery, and cesarean section are also described.

1. Breech presentation
By
Mirza Dilshad Alam
HA(CTEVT)

2. Definition
• The presentation in which the fetus lie is longitudinal and the
podalic pole presents at the pelvic brim. It is the commonest
malpresentation

3. Classification of breech
• Complete breech
• Incomplete breech
• a) Frank breech
• b) Footling presentation
• c) Knee presentation

4. Complete breech
• Both hips and knees are flexed

5. Frank breech
• Hips flexed and knees extended

6. Footling presentation
• Both the Hips and knees are partially extended

7. Knee presentation
• Hips are extended but knees are flexed

8. Factor responsible for breech presentation
(causes)
• Prematurity:-commonest cause
• Factors preventing spontaneous version:(a) Breech with extended legs, (b)
Twins,
• (c) Oligohydramnios, (d) Congenital malformation of the uterus such as septate
or bicornuate uterus, (e) Short cord, relative or absolute, (f) Intrauterine death
of the fetus.
• Favorable adaptation: (a) Hydrocephalus—big head can be well
accommodated in the wide fundus, (b) Placenta previa, (c) Contracted pelvis,
(d) Cornu-fundal attachment of the placenta—

9. Undue mobility of the fetus: (a) Hydramnios, (b) Multiparae with
lax abdominal wall.
Fetal abnormality: Trisomies 13, 18, 21, anencephaly and
myotonic dystrophy due to alteration of fetal muscular tone and
mobility

10. Diagnosis of breech presentation
• Clinical:
• A) Per abdomen
• B) Per vaginam
• Sonography:

11. Per abdomen
• Hard round and ballotable fetal head is found to occupy the
fundus
• The soft irregular structure is movable in pelvic inlet(not engaged)
Or beneath pelvic symphysis(engaged)
• FHS heard loudest above the umbilicus

12. Per vaginam
• Frank breech: Both ischial tuberosities, sacrumand anus are
palpable
• Complete breech: Feet may be felt alongside the buttock
• Footling presentation: one or both feet are inferior to the buttock
• Kneel presentation: Knee is felt

13. Sonography
• ULTRASONOGRAPHY is most informative.
• (1) It confirms the clinical diagnosis
• (2) It can detect fetal congenital abnormality and also congenital anomalies of
the uterus.
• (3) Type of breech (complete or incomplete).
• (4) It measures biparietal diameter, gestational age and estimated weight
• of the fetus.
• (5) It also localizes the placenta.
• (6) Assessment of liquor volume (important for ECV).

14. Mechanism of labor in breech presentation
• Sacro-Anterior Position: Principal movements occur at three places- Buttocks,
shoulders and head.
• Each of the three components undergo cardinal movements as those of normal
mechanism of labor

16. Mechanism of breech delivery video

17. Management
• Identification of the complicating factors related with breech
presentation
• External cephalic version
• Vaginal delivery
• Caesarean delivery

18. Vaginal breech deliveries
• 1.Spontaneous breech delivery:without traction or manipulation
other than infant support
• 2.Assisted breech delivery:
• delivered by the help Or extraction of the operator or various
maneuver
• 3.Breech extraction:The entire body is extracted by the operator

20. Thank you