Complication Of Labour & delivery : Breech Presentation

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