Breech

Question 1

What is breech presentation?

Answer 1

Malpresentation - the feet or buttocks are the presenting part

Question 2

What is the classification of breech?

Answer 2

1. Frank breech
2. Complete breech
3. Incomplete breech (footling)

Question 3

Describe each class of breech.

Answer 3

Frank - hips flexed and knees extended
Complete - hips and knees flexed
Incomplete (footling) - one leg protruding at the pelvis

Question 4

At what gestation do babies turn cephalic?

Answer 4

32 weeks

Question 5

What are the risk factors for breech?

Answer 5

1. Uterine structure
   - Multiparity, fibroids, uterine surgery
2. Altered foetal mobility
   - Prematurity, macrosomia, twins, amniotic fluid
3. Pelvic block
   - Pelvic mass, narrow pelvis, placenta praevia

Question 6

What are the complications of breech?

Answer 6

Cord prolapse
Acute hypoxia during delivery
Trauma during delivery

Question 7

How is breech prevented?

Answer 7

Postural management
Moxibustion (accupuncture)

Question 8

How is breech managed?

Answer 8

1. ECV
2. Elective C-section
3. Vaginal breech delivery

Question 9

What is ECV and when it is it performed?

Answer 9

External Cephalic Version (manipulation of position through the maternal abdomen)

• Nullip = 36w
• Multip = 37w

Question 10

What are 5 complications of ECV?

Answer 10

1. Cord entanglement
2. Foetal distress
3. ROM or APH
4. Pain and discomfort
5. Failure

Question 11

When is an elective C-section performed in a breech baby?

Answer 11

39 weeks (wait for baby to turn)

Question 12

What is the criteria for a vaginal breech delivery?

Answer 12

Frank or complete breech (not footling)
Satisfactory growth (<3.5kg)
Adequate pelvis
No abnormality on U/S
Experienced clinician

Question 13

What are the complications of a vaginal breech delivery?

Answer 13

Cord prolapse
Head entrapment
Trauma
Nuchal arm
Asphyxia

Question 14

How is an unstable lie managed?

Answer 14

Admit at 37 weeks and aim to deliver at 39-40 weeks

If baby turns cephalic, wait for 48 hours to see if stable - discharge if <38w, IOL if >38w