Breech Presentations

 A breech presentation is more hazardous to a fetus than a cephalic presentation because there
is a higher risk of the following
o Developing dysplasia of the hip
o Anoxia from a prolapsed cord
o Traumatic injury to the after-coming head (possibility of intracranial hemorrhage or
anoxia)
o Fracture of the spine or arm
o Dysfunctional labor
o Early rupture of the membranes because of the poor fit of the presenting part
o Meconium staining

 Risk factors
 o Abnormal amniotic fluid volume
o High parity with uterine relaxation
o Prior breech delivery
o Hydrocephaly
o Anencephaly
o Pelvic tumors
o Uterine anomalies
o Multifetal gestation
o Early gestational age
o Placenta previa
o Fundal placental implantation

Three types of vaginal breech deliveries are described:

1. Spontaneous breech delivery:

a. No traction or manipulation of the infant by the clinician is done. The fetus delivers
spontaneously on its own. This occurs predominantly in the very preterm deliveries.
2. Assisted breech delivery:
a. This is the most common mode of vaginal breech delivery. In this method a “no touch
technique” is adopted in which the infant is allowed to spontaneously deliver up to the
umbilicus, and then certain maneuvers are initiated by the clinician to aid in the delivery
of the remainder of the body, arms, and head.
3. Total breech extraction:
a. In this method, the fetal feet are grasped, and the entire fetus is extracted by the
clinician. Total breech extraction should be used only for a non-cephalic second twin; it
should not be used for singleton fetuses because the cervix may not be adequately
dilated to allow passage of the fetal head.

Indications:

 Frank of complete breech (not footling)

 Estimated fetal weight between 1.5 kg and 3.5 kg
 Gestational age (36-42 weeks)
 Well-flexed fetal head (no evidence of hyperextension of the fetal head)
 Adequate pelvis (no fetopelvic disproportion)
 Normal progress of labor on the partogram
 Uncomplicated pregnancy (no contraindications to vaginal birth, e.g. placenta previa, severe
IUGR, etc.)
 Multiparas
 No obstetric indication for cesarean section, e.g. placenta previa, etc.
 An experienced clinician
  Presence of severe fetal anomaly or fetal death
 Mother’s preference for vaginal birth
 Delivery is imminent in case of breech presentation

Procedure

1. Gather all items you will need for the internal examination
a. For easy accessibility for the inspection of the external genitalia.
2. Identify the client, introduce yourself and explain the procedure (internal examination)
a. To obtain client’s cooperation and work simultaneously.
3. Position the client on the examination table.
a. Three positions are employed for internal examination:
i. Doral Recumbent
ii. Sim’s Position
iii. Knee-chest Position
b. The aforementioned positions are made best so as to expose the gynecologic area to be
examined
c. Position depends on client’s capability and examiner’s preferred position
4. S
5. Wash hands- and put- on sterile gloves
a. Protect the health care provider from contracting gynecological diseases caused by
highly infective organisms.
6. Explain the necessity of effective pushing in the second stage of labor
a. Spontaneous descent and expulsion to the umbilicus should occur with maternal
pushing only DO NOT PULL ON THE BREECH!
b. Rotation of the sacrum anterior position is desired

Delivery of the baby’s leg

7. Groin Traction
a. In single groin traction, Hook the index finger of one hand in the groin fold and traction
is exerted towards the fetal trunk