MECHANISM OF LABOR

IN
BREECH PRESENTATION

Prof. Hidayat Wijayanegara, dr., SpOG(K)

Department of Obstetrics & Gynecology

Medicine School of Padjadjaran University
Bandung
 PREDISPOSING FACTORS :

 Prematurity

 Uterine abnormalities : Malformation;

Fieroids

 Fetal abnormalities : CNS, Malformations;

Neck Masses

 Multiple gestations
Figure 21-1. Types of breech presentations. (Reproduced,
With permission, from Benson RC: Handbook of Obstetrics
& Gynecology, 8th ed. Lange, 1983)
DIAGNOSIS :

 Palpation and ballottement

 Ultrasound

 Pelvic examination

 X-Ray studies
Leopold Maneuver
 External Cephalic Version

T
Figure 21-2. Breech presentations. A: Right sacrum posterior (RSP) position. B: Left sacrum
anterior (LSA) position. (Redrawn and reproduced, with permission, from Bumm E: Grundiss zum
Studium der Geburtshilfe. Bergmann, 1922)
 MANAGEMENT DURING LABOR

Type of Delivery
 Cesarean of delivery

 Vaginal delivery:
 Spontaneous
 Partialbreech extraction
 Total breech extraction
Mechanism of Labor in Breech Delivery
Assisted Delivery of Frank Breech
Assisted Delivery of Frank Breech
Assisted Delivery of Frank Breech
Assisted Delivery of Frank Breech
Assisted Delivery of Frank Breech
Assisted Delivery of Frank Breech
Assisted Delivery of Frank Breech
Mechanism of Labor in Breech Delivery

Figure 21-5. Maneuver for delivery of the head. The fingers of the left hand
are inserted into the infant’s mouth of over mandible; the right hand exerts
pressure on the head from above. (Modified and reproduced, with
permission, from Benson RC:Handbook of Obstetrics & Gynecology, 8th ed.
Lange, 1983)
Mauriceau Maneuver
Delivery of the Aftercoming Head

 Piper forceps

 Modified prague maneuver

Forceps to Aftercoming Head
Mechanism of Labor in Breech Delivery

Figure 21-12. Application of Piper forceps, employing towel sling support. The forceps are
introduced from below, left blade first. Aiming directly and intended positions on sides of
the head. (Reproduced, with permission, from Benson RC:Handbook of Obstetrics &
Gynecology, 8th ed. Lange, 1983)
Forceps to Aftercoming Head
Modified Prague Maneuver
Complete or Incomplete Breech Extraction
Complete or Incomplete Breech Extraction
Complete or Incomplete Breech Extraction
Complete or Incomplete Breech Extraction
Breech Extraction
 Section Indication

 A large fetus ( > 3.500 gr )

 A Hyperextended fetus
 Uterine dysfunction
 Footling presentation
 Any degree of contraction or un favorable
shape restriction
 Previous perinatal death or children suffering
from birth trauma
 COMPLICATIONS

1. Perinatal morbidity and mortality from difficult delivery

2. Low birthweight from preterm delivery, growth
restriction, or both
3. Prolapsed cord
4. Placenta previa
5. Fetal, neonatal, and infant anomalies
6. Uterine anomalies and tumors
7. Multiple fetuses
8. Operative intervention, especially cesarean delivery