Mechanism of labour in breech

Amarendra B. Singh
090201263
 Positions

* Left sacro-anterior.
* Right sacro-anterior.
* Right sacro-posterior.
* Left sacro-posterior.
* Left and right sacro- transverse (lateral).
* Direct sacro-anterior and posterior.

8/18/2013 Breech - Mech of labour 2

8/18/2013 Breech - Mech of labour 3
 Mechanism of labour
• Delivery of the breech (Buttocks and lower
limbs)
• Delivery of the shoulders and arms
• Delivery of the head

8/18/2013 Breech - Mech of labour 4

 Delivery of lower limbs and
buttocks
• Engagement
• Descent
• Flexion
• Internal rotation
• Birth of Buttocks

8/18/2013 Breech - Mech of labour 5

 Delivery of the buttocks
* The engaging diameter is the
bitrochanteric diameter 9.5cm which
enters the pelvis in one of the oblique
diameters.

8/18/2013 Breech - Mech of 6

labour
The anterior buttock meets the pelvic floor
first so it rotates 1/8 circle anteriorly .
* The anterior buttock hinges below the
symphysis

8/18/2013 Breech - Mech of labour 7

and the posterior buttock is delivered first by
lateral flexion of the spines followed by
the anterior buttock.
* External rotation occurs so that the sacrum
comes anteriorly.

8/18/2013 Breech - Mech of labour 8

 Delivery of shoulders and arms
• Engagement
• Descent continuous
• Internal rotation
• Birth of shoulders
• Restitution

8/18/2013 Breech - Mech of labour 9

 Delivery of the shoulders

* The shoulders enter the same oblique

diameter with the bisacromial diameter 12
cm (between the acromial processes of
the scapulae).

8/18/2013 Breech - Mech of labour 10

• The anterior shoulder meets the pelvic
floor first, rotates 1/8 circle anteriorly,
hinges under the symphysis, then the
posterior shoulder is delivered first, the
baby is then lowered and the anterior
shoulder and arms pass out under the
symphysis
.

8/18/2013 Breech - Mech of labour 11

 Birth of after coming head
• Engagement
• Descent
• Flexion
• Internal rotation
• Birth of the head

8/18/2013 Breech - Mech of labour 12

• Descent and Engagement: The head
enters the pelvis in the left oblique
diameter. The occiput is in the right
anterior quadrant of the pelvis.

8/18/2013 Breech - Mech of labour 13

• Flexion: It is important that flexion is
maintained.
• Internal rotation: The head strikes the pelvic
floor and rotates internally so that sagittal
suture comes to lie in anteroposterior
diameter
.

8/18/2013 Breech - Mech of labour 14

 • Birth of the head by flexion: The nape of
the neck pivots under the symphysis and
the chin, mouth, nose, forehead, bregma,
and occiput are born over the perineum by
a movement of flexion.

8/18/2013 Breech - Mech of labour 15