Complications of a breech labour and delivery

•cord prolapse = footling breech.

•CTG abnormalities = cord compression
•Mechanical difficulties with the delivery of the
shoulders and/or after-coming head, leading
to damage of the visceral organs or the
brachial plexus.
•Delay delivery head = larger fetus, leading to
prolonged compression umbilical cord +asphyxia.
•Uncontrolled rapid delivery of the head may
occur with a smaller fetus and predisposes to
tentorial tears and intracranial bleeding.
•A small or preterm fetus may deliver through an
incompletely dilated cervix, resulting in head
entrapment.
 Review
•ECV has a high success rate (51–66%) and
should be encouraged.
•Ensure the fetal back does not rotate
posteriorly during breech delivery.
•The most obstetrician available should directly
supervise vaexperienced ginal breech delivery.
•With all breech deliveries, an episiotomy is
made and is an important adjunct to delivery
with adequate anesthesia
•cesarean delivery is preferable for the
premature breech.
 Brow presentation
Brow presentation arises when there is
•less extreme extension of the fetal neck than that
with a face presentation.
•It is the least common malpresentation (1 in 2,000).
•It is a midway position between vertex and face, the
head is partially deflexed (extended), with the largest
diameter of (mento‐vertical, 13.5 cm).
•Diagnosis by vaginal examination when identifying
the prominent orbital ridges lying laterally, anterior
fontanelle, supraorbital ridges and nose, or
sonographic studies.
•This is incompatible with a vaginal delivery.
•Cause
•Excessive tone of the extensor muscles of the fetal
neck.
Rarely, a fetal anomaly such as a thyroid tumour.
placenta previa, polyhydramnios, uterine
anomalies, and fetal malformations.
cephalopelvic disproportion
exaggerated extension with an OP position.
•Cautious augmentation with oxytocin should only
be considered in nulliparous patients for delay in
the early active phase of labour. If brow
presentation persists, emergency CS is
recommended.
•Cord prolapse is more common and, though rare,
uterine rupture can occur in neglected labour or
with injudicious use of oxytocin.
•Preterm labour is best managed in the same way
as term labour, with delivery by CS if progress
slows or arrests.
 Face presentation
•Occurs in about 1 in 500, due to complete
extension of the fetal head.
•The presenting diameter is the submento-
bregmatic (9.5 cm) and is approximately the same
in dimension as the suboccipitobregmatic (vertex)
presentation.
•Engagement of the fetal head is late and progress
in labour is frequently slow, possibly because the
facial bones do not mould ( facial swelling
•causes similar brow presentation.
•Diagnosis in labour by palpating the nose, mouth
and eyes on vaginal examination.
•It is either ( mento-anterior position =-DELIVERY )
when the chin is anterior, or (mento-posterior
position = CS) when the chin is posterior position.
Because no flexion in head
•Progress in labour is good when the chin remains
mento-anterior and vaginal delivery is possible.
•Delivery is impossible with mento-posterior position
as extension over the perineum cannot occur.
 SHOULDER PRESENTATION
•This is occurring in 1 in 300 pregnancies at term,
but fewer will go into labour.
•Shoulder presentation occurs as the result of a
transverse or oblique lie of the fetus(the fetal head
lies in one maternal iliac fossa and the buttocks
•Causes of this abnormal presentation include
placenta praevia, high parity (uterine laxity),
prematurity, pelvic tumour and uterine anomaly
•Delivery should be by caesarean section.
•Delay in making the diagnosis risks cord prolapse
and uterine rupture