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1
Incidence:
20% at 28wk
5% at 34wk
3% at term
Clinical variety
1. Uncomplicated=no oth
er risk factors
2. Complicated=+ other ri
sk factors
2
Types of breech
TYPES
of
BREECH
Complete
Incomplete
(flexed)
Frank
(extended) Footling Knee
3
Cause
Prematurity For adaptation
-ve to version 1. Placenta previa,
1. Frank br., 2. Hydrocephalus,
2. Twins, 3. Contracted pelvis
3. Oligohydramnios,
4. Uterine anomaly,
5. Short cord,
6. IUFD
4
Dx
Obstetric exam
USG
X-ray
5
Mechanism of Labor 1
Engages in Bitrochanter
ic diameter
Descent of buttock
6
Mechanism of Labor 2
Int.rotation of ant.buttock
7
Mechanism of Labor 3
1. Del. Of trunk
2. Engagement of
shoulder
8
Mechanism of Labor 4
Restitution of buttock
Int.rotation of shoulder
Engagement of head
9
Mechanism of Labor 5
1. Del. Of shoulder
2. Int.rotation of occiput
10
Mechanism of Labor 6
Restitution of shoulder
External rotation of
shoulder
Head del.
11
Handling Breech 1
Groin hooked by a
finger to deliver
extended leg
12
Handling Breech 2
13
Handling Breech 3
14
Handling Breech 4
15
Handling Breech 5
Delivery of shoilder
16
Handling Breech 6
17
Handling Breech 7
18
Handling Breech 8
19
Handling Breech 9
20
Handling Breech 10
21
Handling Breech 11
Lovset’s maneuver to di
sengage and deliver arms.
22
Risk of breech del. 1
+ Perinatal mortality
23
Risk of breech del. 2
Perinatal morbidity
1. Intracranial bleeding
2. Asphyxia
3. Fracture
4. Brachial plexus injury
5. Visceral injury
24
Indication of CS
Cord prolapse
Fetal distress
25
Methods of vaginal breech del.
1. Spontaneous
2. Assisted
3. Breech extraction Entire fetus delivered
by obstetrician
After IPV of 2nd twin
Cord prolapse
Arrest of extended leg in pelvic cavity/outlet
26
Principle of breech del.
Not to hurry
27