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Breech Presentation. Incidence. 3-4% of fetus present by breech at term 7% at 32 weeks 25% at 28 weeks 20% diagnosed in labour. External Cephalic Version. Best evidence states that ECV should be offered late in pregnancy Success rate increased with: multiparity adequate liquor
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Incidence • 3-4% of fetus present by breech at term • 7% at 32 weeks • 25% at 28 weeks • 20% diagnosed in labour
External Cephalic Version • Best evidence states that ECV should be offered late in pregnancy • Success rate increased with: • multiparity • adequate liquor • station of breech above the pelvic brim
Types of Breech Frank Complete Footling
Breech Delivery The essence of the vaginal breech delivery is allowing as much spontaneous delivery by uterine action and maternal effort as possible Operator intervention should be limited to the following manoeuvres
Breech Delivery The cervix should be fully dilated and the fetal anus visible on the perineum for active second stage.
Breech Delivery Consider lithotomy position.
Breech Delivery Delivery of the breech should be ‘hands off’ Legs and abdomen are born spontaneously.
Breech Delivery Ensure that the fetal back rotates uppermost by carefully grasping the fetal pelvis with fingers & thumbs. Leg delivery may need knee flexion by pressure in popliteal fossa
Breech Delivery The fetus should be allowed to hang once the legs and abdomen have emerged until the wings of the scapula are seen.
Lovset’s Manoeuvre Grasp the fetus around the bony pelvis with the thumbs across the sacrum. The fetal back should then be turned through 180 degrees until the posterior arm comes to lie anteriorly…….
Lovset’s Manoeuvre The elbow will appear below the symphysis pubis and the arm is delivered by sweeping it across the fetal body. The manoeuvre is repeated in reverse to deliver the other arm.
Breech Delivery Allow the fetus to hang from the vulva until the nape of the neck is visible. Then carry out Mauriceau-Smellie-Veit manoeuvre
