ANTENATAL

MANAGEMENT
ARAVIND V P
37
Management of breech Presentation
External Cephalic Version

1) Timing : ECV is considered at 35 - 37 weeks but can be attempted at

anytime upto early labour
2) Benefits - reduction in incidence of breech Presentation at term & breech
delivery , reduction in caesarean section
3) Contraindications - APH , Multiple pregnancy , ruptured membranes ,
contracted pelvis , congenital malformations , fetal causes - IUGR
4) Failure of version - Breech with extended legs , scanty liquor , Big baby
5) Complication - accidental haemorrhage , membrane rupture
CAESAREAN SECTION

Indications - Big baby , Hyperextension of head , Footling presentation - risk of

cord prolapse , Suspected pelvis contraction , associated complications
VAGINAL DELIVERY

First stage - as other presentations

Second stage - delivered by

1) Spontaneous breech delivery

2) Assisted breech delivery --
•Delivery of buttocks - pt is asked to bear down during uterine
contractions and relax until perineum is distended with buttocks , an
episiotomy is done , legs are hooked out without traction
 ● Delivery of shoulders - a) gentle steady downward traction is applied to
foetal pelvic gridle to bring shoulders in AP diameter of pelvis.

b) When anterior scapula appears below the

symphysis , both arms are delivered by hooking the index finger at elbow and
sweep forearm across the chest of foetus

c) the back is rotated anteriorly

Delivery of the after coming head

a) Jaw flexion - shoulder traction ( Mauriceau - Smellie Viet) - the index

and ring finger are placed on each shoulder while the middle finger is
pressing against the occiput to promote flexion and act as a splint for neck ,
preventing hyperextension and cervical spine injury . Traction is commenced
downwards and backwards till nape of foetus appears , body is lifted
towards the mother’s abdomen
b) Burns - Marshall’s method - the foetus is left hanging so that its weight
exerts gentle downwards and backwards traction. When nape appears ,
grasp the feet and lift the the body towards the mother's abdomen
c) Forceps delivery - Piper forceps is more suitable as it has perineal but not
pelvic curve and longer shank .Traction is applied downwards and
backwards till nape appears and then downwards and forwards to deliver
head by flexion.
Third stage

Third stage is usually uneventful .The placenta is usually expelled out

soon after delivery of head .