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Management of breech presentation

Conference Paper · February 2012

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Efterpi Tingi
Central Manchester University Hospitals NHS Foundation Trust
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Management of Breech Presentation

Blackpool Teaching Hospitals, NHS Foundation Trust, Blackpool, Lancashire,UK
Efterpi Tingi , Helen Winter , Spyros Chouliaras
1 2 3

FY2, 2ST3, 3ST7

1

Introduction

n
The incidence of breech presentation at 28 weeks of gestation is 28%

o
i iu s
and decreases with increasing gestational age; at term the incidence of

s .
breech presentation is 3-4%.

External cephalic version (ECV) is an effective obstetric intervention to

reduce need for vaginal breech delivery and caesarean section rate and

V r
e er G e n
™

l
is recommended for all women with uncomplicated singleton term breech
t
a
pregnancy. ECV reduces the rate of breech presentation at term; however
s
i P o
r
only 50% of ECV attempts will be successful.

o f
T r s i o n

™ V e
s
Objectives
r i a l

i u T
Our aim was to assess the management of both diagnosed and undiag-

a
n
nosed breech presentations as well as the uptake and success rate of

i t h
e e
external cephalic version (ECV) in our unit.

d w
G t e
r
a r
e sb
Materials & Methods c

s t e e n Conclusions
51 women with singleton breech pregnancies were reviewed retrospec-

o te
tively through the obstetric case notes from August 2010 to January 2011.
a Our ECV uptake was low and none were successful. In addition the num-

P r h
Multiple pregnancies were excluded from the analysis. Auditable stan-
dards were established from RCOG guideline.
ber of undiagnosed breeches was almost equal to the diagnosed ones.

p o s We recommend improved counselling stressing safety and use of suc-

h i s cess models to increase uptake rate . Breech clinic (dedicated ECV ser-

T
Results
The sample consisted of 52 women with singleton pregnancies present-
vice) should be established in order to improve success rate. ECV diary
should be put in place separately to elective Caesarian sections diary.

ing by the breech; 28 were diagnosed antenatally and 24 intrapartum.
Only 57% of the patients, who have been diagnosed antenatally and were
seen in the ANC, had documentation in their notes of all options being
offered (vaginal delivery, Caesarean Section or ECV). Of those offered
ECV, only 31% accepted it. In all the cases it has been unsuccessful.
Of the women with undiagnosed breech presentation 12% underwent in-
duction of labour. In the same group with undiagnosed breech presenta-
tion in labour, only 54% of the patients had documentation of an informed
choice for the mode of delivery.
The final outcome was emergency Caesarean delivery for 58% of women
with undiagnosed breech and 100% of women with diagnosed breech.
There was no significant difference in the APGAR scores at 1 and 5 mins
for neonates, regardless of the mode of delivery.
An audit into reasons for refusal of ECV and annual reaudit are also re-
comended.
References
1. RCOG guideline No.20a: External Cephalic Version and reducing the
incidence of breech presentation, December 2006
2. RCOG guideline No.20b, The management of breech presentation,
December 2006