Describe the hand maneuvers for vaginal breech deliveries. . Identify risk factors inherent in vaginal breech birth. Identify labour guidelines when the breech is presenting.OBJECTIVE OF SESSION List the criteria for selecting candidates for vaginal breech delivery. Describe the mechanism of labour in breech presentation. List the indications for caesarean section in breech presentation.

Safe breech delivery is based on understanding Mechanism of labour Potential risk of breech .

Avoid potential risk by using selection criteria Term . uncompromised baby EFW < 4000 gms Frank or complete breech presentation Head flexed and of normal size Adequate pelvic measurement Spontaneous onset of labour and normal progress of labour .

Indications of caesarean section in breech presentation Large fetus Any degree of contraction or unfavorable shape of pelvis A hyperextented head When delivery is indicated in the absence of spontaneous labour Incomplete or footling breech presentation Severe IUGR Previous poor perinatal outcome Lack of an experienced operator .

Type of breech presentation .

Mechanism of labour in breech presentation Vaginal delivery of breech involves delivery of : Delivery of the buttocks and legs Delivery of the shoulders and arms Delivery of head .

Mechanism of labour in breech presentation (cont.) Delivery of the buttocks and legs: Engagement Descent and flexion Internal rotation Lateral flexion Restitution .

) Delivery of the shoulders and arms : Rotation and lateral flexion Delivery of head : Engagement .Mechanism of labour in breech presentation (cont. rotation and delivery by flexion .

Breech presentation carries risks related to the mechanics of mal-presentation. Understanding the potential risks enables one to† Prevent † Avoid † Minimize .

. Cord prolapse.Risks of breech delivery Birth through partially dilated cervix. Aspiration Rapid compression & decompression of head. Arrest of after-coming head. Rupture of membrane. Cord compression. Birth injuries.

Breech labor guideline Preparation of successful breech delivery begins during 1st stage of labor Maintain intact membrane Expect steady progress Make sure the cervix is fully dilated Enable the mother to reach second stage with ability to push Ensure empty bladder .

Touching baby may stimulate gasp reflex or result in nuchal arm. Beware of time but be patient patient. Do not speed delivery. Traction on baby may cause de-flexion. Most important rule. .Points to remember in breech delivery Best position is when mother is at the edge of the table. Time from delivery from umbilicus to airway should not exceed 5 mins.keep hands off.

Spontaneous breech delivery Although spontaneous breech delivery is theoretically possible. most breech deliveries are assisted. Avoid maneuvers that are not needed. Unnecessary intervention should be avoided. .

Maneuver for assisted breech delivery Maneuver for delivery of buttocks Maneuver for delivery of arms Maneuver for delivery of head .

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