The presentation is said to be Breech when the presenting part at
labour is not the head but the buttocks. Breech presentation is the commonest
malpresentation. Although 40% of babies are breech at 20 weeks, 25% will be at 32 weeks
only 3% are breech at term. It is normal, during pregnancy, for the buttocks of the fetus
to come to lie in the fundus of the uterus.
Conditions predisposing towards breech presentation;
- contracted pelvis
- bicornuate uterus (developmental abnormality)
- uterine fibroid
- placenta praevia
- oligohydramnios (less of liquor around the fetus)
Ultrasound may show the cause and influence
the management.
Extended breech presentation is commonest
– i.e. flexed at the hips but extended at the knees. Flexed breeches sit with
hips and knees both flexed so that the presenting part is a mixture of buttocks, external
genitalia and feet.
Footling breeches are the least common. The
feet are the presenting part and this type has the greatest risk (5-20%) of cord prolapse.
Diagnose of breech presentation should be made
antenatally, both by clinical examination and Ultrasound.
How is Breech presentation Managed?
Manipulation – also known as External cephalic version (ECV) – turning
the breech by manoeuvring it through a forward, less commonly backward, somersault.
Resorted to only if vaginal delivery is planned. Traditionally carried out at 34-36 weeks.
Success rate ~53%.
This is not attempted in: placenta praevia, multiple pregnancy, small-for-date babies, in
mothers with uterine scars, pre-eclampsia or hypertension or those who have a bad obstetric history.
Mode of delivery - Caesarean section is often
advocated on the unproven grounds of safety. Your doctor should discuss all options with
you. Breech delivery will be considered if:
- Experienced obstetrician available.
- Estimated fetal weight 2500-3500g by ultrasound scan
- No evidence of growth retardation.
- Good shape/size of pelvis
- No placenta praevia
- Normal volume of liquor.
- No pre-eclampsia; no fetal distress
If all criteria are met fetal loss may be <1%
(possibly much less).
Check baby for hip dislocation (incidence): also if
vaginal delivery, for paralysis and signs for Central Nervous System injury. |
