Complication following breech presentation

1. NEONATAL COMPLICATION OF BREECH
DELIVERY.
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2. Neonatal complication
• Intrapartum death.
• Asphyxia.
• Hypoxic ischemic encephalopathy.
• Intracranial haemorrhage.
• Trauma to liver , kidney or spleen.
• Dislocation of the neck , shoulder or hip.
• Cord prolapse.
• Occipital diastasis and cerebellar injury.
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3.  Brachial plexus injury.
 Fracture of long bone ( femur, humerus ).
 Fracture of clavicle.
 Separation of epiphyses of scapula, femur, humerus.
 Avulsion of upper cervical spine.
 Skull fracture- Intracerebral injury.
 Hematoma of sternocleidomastoid.
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• Fetal injuries,

4. Umbilical cord prolapse.
• May occur particularly in
the footling or kneeling
breech
• This is caused by the lower most part of the baby not
completely filling the space of the dilated cervix.
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5. • When the water break the amniotic sac it is possible for
the umbilical cord to drop down and become
compressed.
• This can be severely diminished oxygen flow to the baby.
• Can detect by checking
fetal HR-baby may have
bradycardia (HR <120).
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6. • Or can conduct pelvic examination and may see the
prolapse cord.
• Prolapse must be dealt with immediately , if find
prolapse cord, have to move fetus away from the cord
to reduce the risk of oxygen loss.
• In some case , then baby will have to be delivered
immediately by cesarean section.
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7. Intrapartum Asphyxia
• Oxygen deprivation may occur from ei cord prolapse or
prolong compression of the cord during delivery.
• If there is a delay in delivery ,the brain can be damage.
• Oxygen deprivation ,can cause cerebral palsy, one of the
most common type of brain damage is called hypoxic
ischemic encephalopathy –its cause severe
development and cognitive delays, or motor
impairments that become more apparent as the child
continues to develop.
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8. • Such impairment can include epilepsy , development
delay, motor impairment, neurodevelopment delay and
cognitive impairment. (in age of 3-4y can be identify).
• Oxygen deprivation prolong it may cause Death.
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9. Trauma to liver kidney or spleen
• Squeezing the baby’s abdomen can damage internal
organs.
• It is important for the birth attendant to be
knowledgeable ,skilled and experienced with all
variation of breech birth .
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10. Injury to brain and skull
• Rapid passing of the baby’s head through the mother
pelvis, cause rapid decompression of the babies head
may leads to intracranial hemorrhage and cerebral
injury .
• Rapid passing of head can causes rapid decompression
of baby’s head ,in contrast ,a baby going through labor
in the head-down position usually experiences gradual
molding (temporary reshaping of the skull) over the
course of few hours .
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11. • In breech birth this may cause no problem at all ,but it
can injure the brain. This injury more likely in preterm
babies.
• Related to potential head trauma, researchers have
identified a relationship between breech birth and
autism.(neurodevelopmental disorder)
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12. Occipital Osteodiastasis
• is a prominent traumatic lesion in neonates born by
breech, during delivery of after coming head.
• The lesion consists of traumatic separation of the
cartilaginous joint between the squamous and lateral
portion of occipital bone resulting posterior fossa
subdural haemorrhage associated with laceration of
the cerebellum.
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13. Head entrapment
• Cause by the failure of the fetal head to negotiate the
maternal mid pelvis.
• Fetal bitrochanteric diameter ( the distance between
two greater trochanter of fetus) is about same as the
biparietal diameter ( the transverse diameter of the
skull of fetus).
• Simply put the size of the hip are the same as size of the
head.
• Relatively larger buttocks dilate the cervix as effectively
as the head does in the typical head down presentation.
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14. • In contrast , the relative head size of a preterm baby is
greater than the fetal buttocks.
• If the baby is preterm it may be possible for the baby’s body
to emerge while the cervix has not dilated enough for the
head to emerge.
• It can leads to oxygen deprivation or head injury.
• If the arm is extended alongside the head delivery not
occurs.
• If this occurs the loveset maneuvre may be employed.
• It involves rotating the fetal body by holdings the fetal pelvis.
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15. • Twisting the body such
that an arm trails behind
the shoulder ,it will tend
to cross down over the
face to a position where
it can be reached by the
obstetrician‘s finger ,and
brought to a position
below the head.
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16. • A similar rotation in the opposite direction is made to
deliver the other arm.
• In order to present the smallest diameter (9.5cm) to the
pelvis, the baby’s head must be flexed (chin to chest).
• If the head is in a deflexed position, the risk of
entrapment is increased.
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17. Birth injury
• Soft tissue injuries-laceration or abrasion due to
forced obstetric maneuvers.
• Nerve injury-Facial nerve, brachial plexus (mostly)
spinal cord injury.
• Scalp- laceration or abrasion.
• Dislocation of hip, cervical vertebrae.
• Skull-Fractures ,cephalohaematoma.
• Intracranial haemorrhage.
• Bone fractures –fracture of clavicle ,humerus ,femur.
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Types of birth injuries that can happen in breech delivery.

18. Fractures
• Forced obstetric maneuvers been reported as a risk of
soft tissue injury ,long bone fracture and related
neonatal injury.
• Long bone fractures have been attribute to breech
maneuvers during vaginal delivery .
• Fractures of femur is more common (subtrochanteric
and mid-shaft fractures)
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19. Brachila plexus injury
• The cause is excessive traction on the head neck and
arm during birth.
• Downward traction of an infant's arm during breech
birth, may tear the roots of C5and C6.
• This will result in paralysis of deltoid, the short muscles
of the shoulder, and of brachialis and biceps.
• The last two are both elbow flexors, and biceps is also a
powerful supinator of the superior radio-ulnar joint.
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• The arm therefore hangs by the
side, with the forearm pronated
and the palm facing backwards,
like a waiter hinting for a tip
(Erb’s palsy).
• There is sensory loss over the
lateral aspect of the upper arm.

21. References
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4722560/
• http://www.healthguideinfo.com/causes-of-autism/p90977/
• https://www.sciencedaily.com/releases/2009/04/090427091115.htm
• https://en.m.wikipedia.org/wiki/Breech_birth
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22. Thank You !
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