BREECH PRESENTATION

BY

DR ROSEMARY OGU
DEPT OF OBSTETRICS AND GYNAECOLOGY
UPTH
 OUTLINE
 DEFINITION
 INCIDENCE
 TYPES OF BREECH
PRESENTATION
 AETIOLOGICAL FACTORS
 CLINICAL FEATURES
 CLINICAL IMPORTANCE OF
BREECH PRESENTATION
 DEFINITION

 Breech presentation is a type of

malpresentation i.e a fetal
presentation other than vertex.
 The breech is said to present
when either the buttock or foot
or feet of the fetus occupies the
lower uterine pole.
 INCIDENCE
 Varies with gestational age
 30-40% @ 20-25 weeks
 25% @ 28-30 weeks
 16% @ 32 weeks
 3-4 % @ term
 Up to 33% are undiagnosed until
labour
 UPTH 3.2% at term.
 TYPES

 This is based on the attitude of

fetal lower limbs and the breech
in the lower uterine pole.
[Attitude is the relationship of
the various parts of the fetus to
one another]
 Frank or extended breech
 Complete or flexed breech
 Incomplete or footling breech
 FRANK OR EXTENDED
BREECH
 Both lower limbs are extended at
the knee and flexed at the hip
 ~ 50-65 % of all breech
presentation
 Commonest in primigravidae
 COMPLETE OR FLEXED BREECH

 Both lower limbs are flexed at

the knee and at the hip
 Both feet and buttocks occupy
the lower segment
 10-15 % of all breech
presentation
 INCOMPLETE OR FOOTLING
BREECH
 One or both hips extended and
one or both feet occupy the
lower pole
 Seen in multiparous women
 ~ 25-35 % of all breech
presentation
 AETIOLOGICAL FACTORS
 Fetal prematurity
 Fetal anomalies
CNS malformations eg
hydrocephalus
Neck masses
aneuploidy

 Abnormal placental position

-praevia or cornual
 Multiply pregnancies
 Oligo or poly hydramious
 AETIOLOGICAL FACTORS
 Uterine abnormalities;
Malformations
Fibroids

 Abnormally shaped pelvic brim

 Pelvic tumors
 CLINICAL FEATURES
 Incidental finding during routine
clinical examination
 Complaints of epigastric or
subcostal discomfort
 Fetal movement felt in the pelvis
COMPLICATIONS OF BREECH
PRESENTATION
FETAL
 Greater risk of perinatal &
neonatal mortality and neonatal
morbidity
 Risk of death; intrapartum - 10
fold higher
 Term breech fetuses delivered
by vaginal route had 9 fold risk
of PM
 Generally 2-4 fold risk of death
 COMPLICATIONS CONTD
 Cord prolapse
 Intra cranial haemorrhage
 Skeletal injuries; shoulder, cervical
spine and hip joint dislocation,
clavicular, humeral and femoral
fractures.
 Soft tissue injuries, ruptured viscous
 Nerve injuries-klumpke’s palsy, Erb’s
palsy
 Birth asphyxia
COMPLICATIONS CONTINUED
Maternal
Vaginal breech delivery is associated
with less risk to the mother compared
to caesarean section.
 Perineal tears

 Vaginal lacerations

 Para-vaginal haematoma

 Cervicallaceration.
These can occur in difficult assisted
vaginal breech delivery.
COMPLICATIONS CONTINUED
 At Caesarean Section
Anaesthetic risk
Haemorrhage
Increased need for blood
transfusion
 Post operative morbidity
Pain
Fever
Sepsis
Deep vein thrombosis
THANK
YOU !