Breech Presentation

BREECH PRESENTATIONNUR AZWANI BINTI MAMATNUR ALYA INANI BINTI ROSNI

What is BREECH?• Lower part of human trunk; buttocks; rump

What is BREECH PRESENTATION?• Position of fetus during labor in which the

buttocks or feet appear first / longitudinal lie

ETIOLOGY• Maternal Factors1. Uterine abnormalities2. Polyhydromnions, oligohydromnions3. Neoplasms• Placenta factors1. Implantation of placenta in either cornual fundal region • Fetal Factors1. Multiple pregnancy2. Hydrocephaly3. Chromosomal abnormalities

CLASSIFICATION

DIAGNOSIS OF POSITION

ABDOMINAL EXAMINATIONBy leopold’s maneuver.

VAGINAL EXAMINATION

SONOGRAPHY

MECHANISM OF LABORDELIVERY OF THE BUTTOCKS AND THE LOWER LIMB• Engagement• Descent• Flexion• Internal rotation• Lateral flexion

DELIVERY OF THE SHOULDERS AND ARMS• Engagement• Descent • Internal rotation • Birth of shoulder by lateral flexion

DELIVERY OF THE HEAD• Engagement• Descent• Flexion• Internal rotation• Birth of head by flexion

MANAGEMENT OF BREECH PRESENTATION

Delivery can be classify into vaginal delivery and cesarean section.

Manual Assistance in Frank Breech Presentation

(Tsovyanov)

• When hips are delivered, they are grasped by hands• the delivered body is lifted to direction of extended pelvis

axis.• As the fetus body expelled from uterus, moves hand in

direction of pudendal cleft of parturient • As shoulder is delivered, the arms prolapse spontaneously• Head is delivered by expulsive effort, but if delayed, assist

by Mauriceau – Levret manoeuvre.

Conduct of labour In Footling Presntation

( Tsovyanov’s Method)-legs retained in vagina until uterine os completely opened. -places palm over external genitalia with a sterilenapkin to prevent expulsion of legs. -As fetus moves along birth canal , it presses sacral nerve

plexus, intensify uterine and abdominal contractions lead to complete opening cervical os.

-With downward thrust descending hips, the pudendal cleft opens , legs shown. Further labor is conducted

Manual Assistance in Breech Presentations

• The delivered body held by its legs

• Place hands around thighs with thumbs over buttocks pointing along spine

• Rotate through 180 degrees with back

uppermost applying gentle traction • Locate arm and sweep across

face and down chest carefully to deliver.

• Repeat manouvre to deliver second arm.

• Head enters pelvic brim in the oblique or transverse diameter

• Occiput rotates forward accompanied by simultaneous external rotation of body to back uppermost.

COMPLICATION OF BREECH PRESENTATION

1. Prolapse of the umbilical cord2. Arm of fetus broken3. Head fixed on the sacrum