BREECH PRESENTATION

YEAR THREE
OBJECTIVES
By the end of the session the students should be able to:
Define a breech presentation
List the causes of a breech presentation
Outline how to diagnose a breech presentation
Describe the antenatal management of a breech
presentation
Outline the management of breech presentation at a
Rural Health Centre (RHC)
List the complications of a breech presentation

defintion
Breech presentation is when the buttocks of the fetus
lie in the lower pole of the uterus.
Causes/predisposing factors
Contracted pelvis
Preterm labour (mainly before 34 weeks)
Multiple pregnancy
Fibroids or a low lying placenta preventing the head from
entering the pelvis.
Hydocephalus
Grand multiparity
Intrauterine death
Polyhydramnios
Oligohydramnios
 Abnormal uterus
Diagnosis of breech
History
The woman complains of feeling discomfort under the ribs due
to pressure from the head.

Abdominal examination
Inspection - The abdomen may look a little more ovoid.
Palpation - In the pelvis a soft indefinable mass that is less
round than the head is felt.
 In the fundus a round hard ballotable mass can be felt.
Auscultation - The fetal heart is usually heard above the level of
the umbilicus
Vaginal examination
The presenting part is high
A soft irregular mass can be felt
No sutures and fontanelles can be felt
Buttocks, feet or knees may be felt.
Management
Antenatally
If the woman is below 34 weeks gestation then wait
and see if the breech will convert to a cephalic
without assistance.
The woman should be seen again at 34 weeks and if it
has remained a breech presentation then she
should be referred to the next level of care depending on
which level you are ,
If during the admission in labour a breech presentation
is diagnosed then the following action should
be taken:-
Organise transfer to the next level of care for further
management
While awaiting transport observe fetal heart ½ hourly
Observe contractions half hourly
Observe Blood pressure & pulse half hourly
Accompany the woman and carry a delivery pack.
