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Objectives
Incidence and Significance
Selection
Management
Intrapartum
Delivery
Definition
longitudinal lie
breech or lower extremity presenting
cephalic pole in the uterine fundus
Types
frank
complete
footling
Types of Breech
Complete
Footling
Frank
Incidence
3 to 4% of all pregnancies
increases with decreasing gestational age
7 to 10% at 32 weeks
25 to 35% at < 28 weeks
idiopathic
prematurity (head to trunk size)
uterine or pelvic structural abnormality
uterine fibroid
fetal anomaly or abnormality
polyhydramnios
multiple gestation
Diagnosis
Ultrasound Assessment
Management in Labour
Management at Delivery
experienced newborn resuscitator present
empty maternal bladder
maternity attendant with experience in breech
delivery
forceps if available, may be helpful
Spontaneous Expulsion
spontaneous expulsion to the
umbilicus
the sacrum should be gently
guided anteriorly
singleton breech extraction is
contraindicated
C/S is indicated for failure of
descent or expulsion
Obstetrics - Normal and Problem Pregnancies, 2nd Edition
Edited by SG Gabbe, JR Niebyl, JL Simpson. (1991)
Delivery of Arms
good maternal pushing
deliver when winging of
scapulae seen
rotate arm to anterior
sweep humerus across the
chest and deliver
rotate other arm anterior
and repeat to deliver
Obstetrics - Normal and Problem Pregnancies, 2nd Edition
Edited by SG Gabbe, JR Niebyl, JL Simpson. (1991)
Avoid Over-extension
Prevention of Breech
consider external cephalic version at 36 weeks
gestation for eligible candidates
success rate 30 - 70% depending on experience
results in lower cesarean section rate
Conclusions