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Breech presentation

Prepared by:

Dr. Gehanath Baral


MBBS,DGO,MD
Senior Consultant Gynecologist & Obstetrician: Gov
ernment of Nepal
Visiting Professor: CTGU
27th March,2007

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Incidence:
 20% at 28wk
 5% at 34wk
 3% at term
Clinical variety
1. Uncomplicated=no oth
er risk factors
2. Complicated=+ other ri
sk factors

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Types of breech
TYPES
of
BREECH

Complete
Incomplete
(flexed)

Frank
(extended) Footling Knee

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Cause
 Prematurity  For adaptation
 -ve to version 1. Placenta previa,
1. Frank br., 2. Hydrocephalus,
2. Twins, 3. Contracted pelvis
3. Oligohydramnios,
4. Uterine anomaly,
5. Short cord,
6. IUFD

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Dx

Obstetric exam

USG

X-ray

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Mechanism of Labor 1

 Engages in Bitrochanter
ic diameter

 Descent of buttock

 Ant. Buttock touches pe


lvic floor

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Mechanism of Labor 2
Int.rotation of ant.buttock

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Mechanism of Labor 3

1. Del. Of trunk

2. Engagement of
shoulder

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Mechanism of Labor 4

 Restitution of buttock

 Int.rotation of shoulder

 Engagement of head

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Mechanism of Labor 5

1. Del. Of shoulder

2. Int.rotation of occiput

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Mechanism of Labor 6
 Restitution of shoulder

 External rotation of
shoulder

 Head del.

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Handling Breech 1

 Groin hooked by a
finger to deliver
extended leg

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Handling Breech 2

 Assisted breech del.

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Handling Breech 3

 Both groins traction(hoo


ked by both hands) for
delayed breech del.

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Handling Breech 4

 Way to deliver leg

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Handling Breech 5

 Delivery of shoilder

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Handling Breech 6

 Breech hanged with occiput


at sub-pubic region for head
del. (Burns-Marshall method
step 1)

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Handling Breech 7

 Legs lifted up to the


abdomen
(Burns-Marshall method
step 2)

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Handling Breech 8

 Forceps for after


coming head

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Handling Breech 9

 After coming head del.


By neck flexion and
shoulder traction

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Handling Breech 10

 After coming head del.


By malar traction

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Handling Breech 11

Lovset’s maneuver to di
sengage and deliver arms.

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Risk of breech del. 1

 + Operative delivery Forceps, CS

 Genital tract injury

 + Perinatal mortality

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Risk of breech del. 2

 Perinatal morbidity
1. Intracranial bleeding
2. Asphyxia
3. Fracture
4. Brachial plexus injury
5. Visceral injury

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Indication of CS

 Breech with complication due to high risk factor

 Arrest of progress of labor/ Obstructed labor

 Cord prolapse

 Fetal distress

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Methods of vaginal breech del.

1. Spontaneous
2. Assisted
3. Breech extraction  Entire fetus delivered
by obstetrician
 After IPV of 2nd twin
 Cord prolapse
 Arrest of extended leg in pelvic cavity/outlet

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Principle of breech del.

 Not to hurry

 Never pull from below but push from above

 Keep back of the fetus always anteriorly

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