What is the definition of breech presentation?
The foetus lies longitudinally with the buttocks in the lower segment of the uterus
What is the bitrochanteric diameter?
- 10cm
- Between the greater trochanters of the femurs
- Same diameter as the head
What is one sign of a breech presentation in labour?
Thick meconium in the waters, similar to what its like in the nappy
What are the 5 types of breech presentation?
- Complete/ Flexed (knees to chest)
- Incomplete (1 leg straight, 1 leg bent)
- Frank (Both legs straight)
- Knee
- Footling
What are the uterine risk factors for breech?
- Poly/ Oli
- Firm abdominal muscles
- Uterine abnormalities
- Placenta praevia
What are the foetal risk factors for breech?
- Prematurity
- Multiple pregnancy
- Hydrocephaly/ Anencephaly
- Grand multiparity
How can breech presentation be diagnosed antenatally?
- Palpation
- Auscultation
- If >36/40 = USS to confirm
How can you tell from a VE that the baby is breech?
- PP feels soft and irregular
- No sutures
- Anus may be felt
- Foot may be felt
- Meconium
What is an ECV?
External Cephalic Version - manipulation of the foetus through the maternal abdomen to a cephalic presentation
When is an ECV usually done?
Primip = 36/40 Multip = 37/40
What are the complications of an ECV?
- Foetal distress
- Obstructed labour
- Instrumental delivery
- Placental abruption
- Fetomaternal haemorrhage
- Cord entanglement
When is an ECV most successful?
- Multiparity (softer muscles)
- Frank breech (easier to hold)
- Normal/ increased amniotic fluid
- Relaxed uterus
- Suitable gestation
What are some contraindications of an ECV?
- Abnormal Doppler/ CTG
- Absolute reasons for CS
- Placenta praevia/ abruption
- Multiple pregnancy
- Rhesus isoimmunisation
- Vaginal bleeding within 7 days
- SROM
- IUD
- Severe preeclampsia
What is the procedure for ECV?
- Empty bladder
- CTG
- Trendelenburg position
- ?Tocolysis/ muscle relaxant
- USS
- Obstetrician turns baby (usually forwards)
- CTG
- Observe for distress, ROM, contractions, bleeding
- Kleihauer (anti-D if needed)
What is the Trendelenburg position and why is it used?
- Lie flat with head lowered
- Relieves pressure on cervix
What is internal podalic version?
Feet pulled down on VE - most commonly used to deliver second twin
What is the best mode of delivery for the mother?
- Complications lowest with successful vaginal birth, highest with EMCS
- LSCS = risk of complications in future pregnancies
What is the best mode of delivery for the foetus?
- Planned LSCS
- Reduction of stillbirth, perinatal morbidity and intrapartum risks
What are some indications for LSCS?
- Hyperextension of the neck on USS
- EFW >3.8kg or <10th centile
- Footling
- AN foetal compromise
When should an ELCS be for breech presentation?
39/40
What advice should be given regarding the method of delivery?
- Hospital birth with facilities for immediate LSCS if needed
- IOL not recommended but consider augmentation
- Epidural increases the risk of intervention
What is the role of the midwife in the 1st stage of labour?
- Same as cephalic presentation
- Membranes may rupture early
- Meconium may be present
What is the role of the midwife in the 2nd stage of labour?
- Confirm full dilation
- Consider position
- Inform MDT
- Be prepared with equipment
What position should the mother not be in for a breech vaginal delivery?
Upright, as gravity could cause placental abruption/ early separation
