What is the presenting diameter?
Bitrochanteric 10cm (distance between the outer points of the hips)
What is the denominator?
Sacrum
What are the types of breech presentation?
Frank breech
Complete breech
Footling breech
Knee presentation
Frank breech
Hips flexed, legs extended on the abdomen.
Common in primips
Complete breech
Hips and knees both flexed and feet tucked in beside buttocks
Footling breech
1 or both feet present as neither hip is fully flexed
Knee presentation
1 or both hips extended, knees flexed
Causes of breech presentation
- extended legs
- preterm labour
- multiple pregnancy
- polyhydramnios
- hydrocephaly
- fibroid or tumor
- placenta praevia
6 pelvic positions for breech presentation
Right sacroposterior RSP
Left sacroposterior LSP
Right sacrolateral RSL
Left sacrolateral LSL
Right sacroanterior RSA
Left sacroanterior LSA
Signs that birth should be assisted
- lack of fetal tone/colour
- delay of >5 mins between birth of buttocks and birth of fetal head (or > 3mins from umbilicus to head)
- delay due to extended arms/neck
Ensure buttocks remain sacroanterior (bum to tum)
Ensure buttocks remain sacroanterior (bum to tum)
Nuchal arms
1 or both of the arms become extended and trapped behind the fetal head.
Baby remains transverse and legs born in this position rather than SA.
Nuchal arms- short rotation
- Prayer hands
- Rotate baby 90 deg into direct SA
- Insert hand and sweep arm down
- Rotate baby back 180 deg which should give the other arm
- Rotate back to direct SA for birth of head
Nuchal arms- long rotation
- Prayer hands
- Rotate to SP and continue all way round
Deflexed head- Franks nudge
- Hold baby gently round shoulders, pivot body back, away from the sacrum
- Maintain hold while head stretches perineal tissue
- Push occiput with middle finger to bring head forwards
Persistent deflexed head- Mauriceau-Smellie-Veit (MSV)
- Wait until nape of neck visible
- Middle finger of one hand on occiput
- Index and ring finger of other hand on cheek bones
- Flex head and deliver baby
- Once hands in place, ask woman to drop forwards
