OBSTETRICS

BREECH PRESENTATION
WHAT IS A BREECH
PRESENTATION?
• In the last weeks of pregnancy, a baby usually
moves so his or her head is positioned to come
out of the vagina first during birth. This is called
a vertex presentation.
• A breech presentation occurs when the baby’s
buttocks, feet, or both are positioned to come
out first during birth.
• This happens in 3–4% of full-term births.
FACTORS INFLUENCING
BREECH DELIVERY

• Mother has been pregnant before.

• There is more than one fetus in the uterus (twins or more).
• There is too much or too little amniotic fluid.
• The uterus is not normal in shape or has abnormal growths such
as fibroids.

•The placenta covers all or part of the opening of the uterus (placenta previa)

•The fetus is preterm.

•Fetal anomalies such as Hydrocephalus.

 TYPES OF BREECH POSITIONS

In this position, the baby’s buttocks are Here, the buttocks are pointing In this position, one or both of
aimed at the birth canal with its legs downward with the legs folded at the baby’s feet point downward
sticking straight up in front of his or her the knees and feet near the and will deliver before the rest of
body and the feet near the head. buttocks. the body.
EXTERNAL CEPHALIC
VERSION

• External cephalic version (ECV) is an attempt

to turn the fetus so that he or she is head
down.
• It can improve the chance of having a vaginal
birth.
• If the fetus is breech and pregnancy is >36
weeks the health care professional may
suggest ECV.
HOW IS ECV PERFORMED?
COMPLICATIONS OF
ECV
• Fetal bradycardia
• Placental abruptions (The placenta has come
away from the wall of the uterus)
• Uterine rupture
• Feto-maternal hemorrhage
• Preterm Labor
 ECV is contraindicated:
• Vaginal Bleeding
• When mother is carrying more than one fetus.
• There are concerns about the health of the fetus.
CONTRAINDICATIONS • When mother has certain abnormalities of the reproductive
OF ECV system.
• The placenta is in the wrong place.
• Placental Abruption
• Presence of low amniotic fluid levels to protect baby.
 COMPLICATIONS OF BREECH FETUS
DURING VAGINAL DELIVERY

• In a breech birth, the baby’s head is the last part of its body to emerge making it more difficult to
ease it through the birth canal.
• The baby’s body may not stretch the cervix enough to allow room for the baby’s head to come
out easily.
• There is a risk that the baby’s head or shoulders may become wedged against the bones of the
mother’s pelvis.
• Cord prolapse is a potential problem during vaginal birth of breech fetus.
• In this situation, the umbilical cord drops through the cervix into the vagina as a result of which it is squeezed as
the baby moves toward the birth canal, thus slowing the baby’s supply of oxygen and blood.
• Birth asphyxia happens when a baby's brain and other organs do not get enough oxygen and nutrients before,
during or right after birth.
• Entrapment of aftercoming head
• It may result from an incompletely dilated cervix and a head that lacks time to mold to the maternal pelvis.
• This occurs in 0-8.5% of vaginal breech deliveries.
• This percentage is higher with preterm fetuses (< 32 wk), when the head is larger than the body.

• In a vaginal breech delivery, electronic fetal monitoring will be used to monitor the baby’s heartbeat throughout the
course of labor.
• Cesarean delivery may be an option if signs develop that the baby may be in distress.
 BREECH BIRTH INJURIES

• Intracranial hemorrhage
• Tentorial tears (Tentorium cerebelli)(forceps use)
• Brachial plexus injuries
• Spinal cord injuries
• Fracture of clavicle, humerus and femur
• Depressed skull fracture
 BIBLIOGRAPHY

• https://www.acog.org/womens-health/faqs/if-your-baby-is-breech#:~:text=In%20a%20breech%2
0presentation%2C%20the,bones%20of%20the%20mother's%20pelvis
.
• https://www.healthline.com/health/pregnancy/breech-baby#causes
• https://emedicine.medscape.com/article/262159-overview#a2
• https://americanpregnancy.org/healthy-pregnancy/labor-and-birth/breech-presentation/
• Google images