Breech/Compound Presentation

Question 1

What are the 3 types of breech presentation?

Answer 1

1. Frank breech - buttocks present first, legs extended over the abdomen (V shape), flexed hips
2. Complete breech - buttocks present first with flexed hips and knees (cross-legged)
3. Footling - one or both feet present first, as neither hips or knees are full flexed.

Question 2

Describe a frank breech.

Answer 2

buttocks present first, legs extended over the abdomen (V shape), flexed hips

Question 3

Describe a complete breech.

Answer 3

buttocks present first with flexed hips and knees (cross-legged)

Question 4

Describe a footling breech.

Answer 4

one or both feet present first, as neither hips or knees are full flexed.

Question 5

Cord prolapse is more common with breech presentation. True or false?

Answer 5

True.

Question 6

If foetus is a known breech and birth not imminent, transport to?

Answer 6

Booked obstetric unit with capacity for surgical intervention.

Question 7

What are the most appropriate positions for a breech birthing mother?

Answer 7

Lithotomy if on a bed/stretcher

Standing/squatting if preferred, though not suitable for transport or imminent birth.

Question 8

Why should touching of the foetus be limited to only absolutely necessary occasions in a breech birth?

Answer 8

Hands off approach allows the baby to maintain a position of flexion which simplifies the birth - if too much stimulus is applied, the baby will extend its flexed head.

Question 9

What is the main force of birth in a breech?

Answer 9

Maternal effort.

Question 10

Why is it important to keep the legs and body of a breech born baby warm?

Answer 10

Cold air may stimulate breathing in the non-birthed head, causing aspiration.

Question 11

In which breech presentation should birthing not be attempted?

Answer 11

One foot, hand or arm presenting.

Consult with piper and Tx urgently with notification.

Question 12

In which breech presentation should birthing be attempted?

Answer 12

Imminent breech birth with buttocks or both feet presenting.

Question 13

What is the Mx in an imminent breech birth where birthing is being attempted?

Answer 13

1. Request urgent assistance
2. Prepare equipment, environment, pt (cultural cons.)
3. Provide analgesia
4. Position in lithotomy and allow birth to occur spontaneously, do not touch baby as it emerges

Question 14

What are the 4 possible subsequent presentations in an imminent breech birth where the legs/buttocks are presenting?

Answer 14

1. Back uppermost
2. Back not uppermost
3. Legs don’t birth spontaneously
4. Arms don’t birth spontaneously

Question 15

What is the management for a breech birth where the back is uppermost?

Answer 15

1. Keep body warm, minimise touching
2. Do not attempt to pull out
3. Allow body to descend to clavicle, arms should swing free
4. Let baby hang until nape of neck visible, facing downward
5. Assist birth of head using modified Mauriceau-Smellie Veit manoeuvre

Question 16

Outline the Modified Mauriceau Smellie Veit manoeuvre.

Answer 16

1. Place index and ring finger of non dominant hand on baby’s shoulders and middle finger on occiput to assist with flexion of head
2. Place dominant hand under baby to support, with ring and index on baby’s cheekbones
3. Slowly lift baby straight up in a circle onto mothers abdo
4. Assistant can aid flexion of the head by applying direct pressure behind the pubic bone

Question 17

What is the management for a breech birth where the back is not uppermost?

Answer 17

1. Gently hold baby by placing thumbs on bony sacrum, fingers around thighs
2. Do not squeeze the abdomen
3. Rotate/turn baby uppermost between contractions, taking care of spine
4. Do not pull the baby

Question 18

What is the management for a breech birth where the legs don’t birth spontaneously?

Answer 18

If legs extended (Frank breech):

1. Slip one hand along leg of baby lying anteriorly
2. Place a finger behind baby’s knee and flex then abduct it to birth

Question 19

What is the management for a breech birth where the arms don’t birth spontaneously?

Answer 19

1. Hold baby by the sacrum
2. Turn baby 90 degrees so that one shoulder is in the antero-posterior diameter.
3. Insert finger into brachial plexus, and sweep arm down over baby’s chest
4. Repeat on opposite side and return baby to back uppermost position for further descent
5. Do not apply traction

Question 20

What is the name of the manoeuvre used in a breech birth where the arms don’t birth spontaneously?

Answer 20

Lovsett’s Manouevre