The course is designed to assists student to acquire comprehensive knowledge of the normal functions of the organ systems of the human body to facilitate understanding of physiological basis of health, identify alteration in functions and provide the student with the necessary physiological knowledge to practice nursing. On completion of the course, the students will be able to 1. Develop understanding of the normal functioning of various organ systems of the body. 2. Identify the relative contribution of each organ system towards maintenance of homeostasis. 3. Describe the effect of alterations in functions. 4. Apply knowledge of physiological basis to analyze clinical situations and therapeutic applications. 1. describe the physiology of cell, tissues, membranes and glands. 2. describe the physiology and mechanism of respiration 3. identify the muscles of respiration and examine their contribution to the mechanism 4. describe the functions of digestive system 5. explain the functions of the heart, and physiology of circulation 6. describe the composition and functions of blood 7. identify the major endocrine glands and describe their functions 8. describe the structure of various sensory organs 9. describe the functions of bones, joints, various types of muscles, its special properties and nerves supplying them. 10. describe the physiology of renal system 11. describe the structure of reproductive system 12. describe the functions of brain, physiology of nerve stimulus, reflexes, cranial and spinal nerves.

1. Breech presentation

2. Definition
The definition of breech
presentation is when the buttocks,
foot or feet are presenting instead of
the head.
It is a longitudinal lie in which
the buttocks is the presenting part
with or with the lower limbs.

3. Incidence
• Single Pregnancy - 3.5%

4. Types
1. Complete Breech – 25 – 30%
– Both knees and hips are flexed
– More common in Multipara
2. Incomplete Breech - 30 – 35%,Buttocks – 70%
a) Frank Breech
b) Footling Presentation
c) Knee presentation

7. Frank breech:
Breech with extended legs
More common in primi gravida
Footling presentation:
Longitudinal lie
Hip and knee joints are extended on one or both
sides
More common in preterm singleton breeches

8. Knee presentation
• Hips is partially extended and the knee is
flexed on one or both sides

9. What are the causes?

10. Maternal factors
• Polyhydraminos
• Uterine anomalies (bicornuate, septate)
• Space occupying lesions (e.g fibroids)
• Placental abnormalities (praevia, cornual)
• Multiparity (in particular grand multips)

11. Fetal factors
• Prematurity
• Fetal anomalies (e.g neurological,
hydrocephalus, anenecephaly)
• Multiple pregnancy
• Fetal death
• Short umbilical cord

12. Complete Breech Presentation

13. Diagnosis
During Pregnancy
• Inspection :
– transverse groove may be seen above the
umbilicus
• Palpation:
– Fundus – Head
– Pelvic grip – buttocks
• Auscultation:
– Above the level of umbilicus
– Frank breech – below the umbilicus
USG

14. During Labour :
Vaginal Examination
– Fresh meconium to be found on the examination
fingers
– Male genetalia may be felt

15. Mechanism of labour

16. Management
should be assessed
carefully before
selection for vaginal
breech birth

17. • External Cephalic version
• Caesarean Section
• Vaginal Delivery

18. unfavourable for vaginal breech birth
● other contraindications to vaginal birth (e.g. placenta praevia,
compromised fetal condition)
● clinically inadequate pelvis
● footling or kneeling breech presentation
● large baby (usually defined as larger than 3800 g)
● growth-restricted baby
● Hyperextended fetal neck in labour (diagnosed with
ultrasound or X-ray where ultrasound is not available)
● lack of presence of a clinician trained in vaginal breech delivery
● previous caesarean section.

19. Intrapartum management
• should take place in a hospital with facilities
for emergency caesarean section
• Labour induction for breech presentation may
be considered if individual circumstances are
favourable
• Labour augmentation is not recommended

20. • Epidural analgesia should not be routinely
advised; women should have a choice of
analgesia during breech labour and birth.

21. • Continuous electronic fetal heart rate
monitoring should be offered to women with
a breech presentation in labour.
• Caesarean section should be considered if
there is delay in the descent of the breech at
any stage in the second stage of labour.
• Episiotomy should be performed when
indicated to facilitate delivery

22. Three types of vaginal breech deliveries
Spontaneous breech delivery
Assisted breech delivery
Total breech extraction

23. Total breech extraction
• only with 2nd non
vextex twin delivery
• procedure in which the
infant's feet are grasped
by the operator and the
fetus is extracted from
the uterine cavity
through the vagina.

24. ECV
• External cephalic version (ECV) is the trans
abdominal manual rotation of the fetus into a
cephalic presentation.
• after ECV successful rate 35-86%
• breech presentation at term, after ECV 1 -
1.5%

26. contraindication to ECV
• preterm
• Multiple pregnancy
• significant third trimester bleeding
• IUGR,
• oligohydramnion
• PROM
• PIH
• nonreassuring foetal monitoring patterns
• all contraindications to vaginal birth are
concerned to execute ECV

27. Risk of ECV
• umbilical cord entanglement
• abruptio placenta
• premature rupture of the membranes (PROM)
• severe maternal discomfort

28. Vaginal Breech Delivery
1. Spontaneous Breech delivery
2. Assisted Breech Delivery
Delivery of the buttocks
Delivery of the shoulders
Delivery of the after coming head

29. Delivery of the head
• Jaw flexion – Shoulder traction (Mauricean –
Smellie Veit ) Method

30. Burns Marshall’s method

31. Breech Extraction

32. Complicated Breech Delivery
1. Arrest of the buttocks at the pelvic brim :
– Breech extraction
– C.Section
2. Arrest of the buttocks at the pelvic outlet
– Breech extraction
– C.Section
– Episiotomy

33. Groin Traction
• Pinard’s Method(Popliteal fossa)

34. Arrest of the shoulders
• Lovset Manoeuvre

35. THANK
YOU