Breech Presentation

Question 1

What is a breech presentation?

Answer 1

Foetus presenting feet / bum first (instead of head first aka cephalic)

Question 2

What percentage of pregnancies present as breech by 28 weeks?

Answer 2

20%

Question 3

What percentage of pregnancies present as breech by 37 weeks?

Answer 3

3%

Question 4

What are the types of breech? (4 things)

Answer 4

1. Complete breech
2. Incomplete breech
3. Extended breech (aka Frank breech)
4. Footling breech

Question 5

What is Complete breech?

Answer 5

Legs fully flexed @ hips + knees

Question 6

What is Incomplete breech?

Answer 6

One leg flexed @ hip + Extended @ knee

Question 7

What is Extended breech (aka Frank breech)?

Answer 7

Both legs flexed @ hip + Extended @ knee

Question 8

What is Footling breech?

Answer 8

Foot presenting through cervix w leg extended

Question 9

What can the RF of Breech be divided into? (2 things)

Answer 9

1. Uterine
2. Foetal

Question 10

What are the Uterine RF for Breech? (4 things)

Answer 10

1. Multiparity
2. Uterine malformations (e.g septate uterus)
3. Fibroids
4. Placenta praevia

Question 11

What are the Foetal RF for Breech? (5 things)

Answer 11

1. Prematurity
2. Macrosomia
3. Polyhydramnios
4. Twins
5. Abnormality (e.g anencephaly)

Question 12

What could suggest Breech even before you see on scan? (2 things)

Answer 12

1. Palpating abdomen: foetal head felt in upper uterus
2. Auscultating heart: Heart heard higher up maternal abd

Question 13

What are some differential Dx that are similar to breech? (3 things)

Answer 13

1. Oblique lie (diagonal)
2. Transverse lie (sideways)
3. Unstable lie (presentation changes everyday)

Question 14

When is unstable lie common?

Answer 14

Polyhydramnios

Question 15

How do you confirm Breech Dx?

Answer 15

US

Question 16

What are the Mx options for Breech? (3 things)

Answer 16

1. External cephalic version (ECV)
2. C section
3. Vaginal breech birth

Question 17

What is External cephalic version (ECV)?

Answer 17

Manipulating foetus to cephalic presentation thru mums abd

Question 18

What is the success rate of External cephalic version (ECV)?

Answer 18

50%

Question 19

What increases the success rate of External cephalic version (ECV)?

Answer 19

Multiparity

Question 20

What is a complication of External cephalic version (ECV)?

Answer 20

Transient foetal heart abn

(transient, so they revert to normal)

Question 21

What is a CI for Vaginal breech birth?

Answer 21

Footling breech

Question 22

Why is Footling breech a CI for Vaginal breech birth?

Answer 22

Feet + legs can slip thru non-fully dilated cervix –> shoulders + head get trapped

Question 23

What are the complications of Breech? (4 things)

Answer 23

1. Cord prolapse
2. Premature rupture of membranes
3. Birth asphyxia (no blood flow to brain)
4. Intracranial haemorrhage

Question 24

Why do you get Intracranial haemorrhage with Breech?

Answer 24

Bc rapid compression of head @ delivery

Question 25

What is cord prolapse?

Answer 25

Umbilical cord drops below presenting part of baby n gets compressed

Question 26

What percentage of Breech get cord prolapse?

Answer 26

1%