risk factors types of breech ECV and Management of breech presentation

1. Breech
Presentation
Dr Ravikanth G O

2. • Definition
• Lie
• Presentation
• Incidence
20%. -28 week
5% -34 week
3-4% by term

3. Broad head accommodate
roomy fundus

4. Etiology of breech
presentation
• Preterm
• Preventing spontaneous version – Frank
breech,twins,oligohydramnion,uterine
malformation,short cord
• Favouring breech– Hydrocephalus,placenta
previa,contracted pelvis,cornufundal attachemet
of placeta

5. 3-4% of fetus present by breech
at term
7% at 32 weeks
25% at 28 weeks
20% diagnosed initially in labour
Incidence

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

10. • Uncomplicated breech
• Complicated breech
• Complication of breech delivery

12. Diagnosis
• Clinical examination
• Ultrasonogram
• CT/MRI
• X-ray

13. Zatuchini andros score

14. Methods of breech delivery
Spontaneous
Assisted
breech delivery
Breech
extraction

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

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

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

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

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

20. 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…….

21. 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.

22. Lovset maneuver

23. 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

24. Delivery of after coming head

25. Complications of
breech delivery
Maternal
Operative delivery
Birth Injury

26. Fetal
complications
Perinatal mortality
Intracranial haemorrhage
Vault fracture
Birth asphyxia
Birth injuries
• Sternomastoid hematoma
• Fracture of femur,humourus,clavicle.
• Visceral injuries
• Nerve injuries

27. External cephalic version
• 37 week
• Benefits of ECV
• Dangers of version
• Anti - D

28. 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

29. Technique
NST
TOCOLYTICS
LEFT LATERAL POSITION
TRENDLENBURGE POSITION
FORWARD FLIP
BACKWARD FLIP
INTERMITENT ASCULATATION

31. Contraindications
of ECV
Any contraindications of vaginal delivery
Scared uterus
In labour
Rh -ve
Oligohydramnion

32. Complications
of ECV
Preterm
labour
PROM
Abruption
Entanglement
of cord
Fetomaternal
bleed
Amniotic fluid
embolism

33. Thank you