Breech presentation

Question 1

Breech presentation

• Definition
• How do you diagnose

Answer 1

When the fetus is lying longitudinally and its buttocks, foot or
feet are presenting instead of its head.

§ Diagnosed by Leopold examination.

1. Xác định cực thai ở đáy tử cung (Fundal Grip):

Sờ phần trên bụng (đáy tử cung).

Kiểm tra xem đó là đầu (cứng, tròn) hay mông (mềm, không đều).

2. Xác định vị trí lưng thai nhi (Umbilical Grip):

Sờ hai bên bụng.

Tìm lưng (cứng, phẳng) và tay/chân (lồi lõm, di động).

3. Xác định phần trình diện (Pawlik’s Grip):

Sờ ngay trên xương mu.

Xem đầu (tròn, cứng) hay mông (mềm, không đều) ở phía dưới.

4. Kiểm tra độ lọt (Pelvic Grip):

Ấn tay gần khung chậu, kiểm tra xem phần trình diện (thường là đầu) đã vào khung chậu hay chưa (di động hoặc cố định).

Question 2

Breech presentation

Associated with what

Answer 2

• Preterm delivery
• Multiple pregnancy
• Fetal and uterine abnormality
• Placenta praevia

Question 3

Types of breech presentation

Answer 3

• Frank breech: Legs are extended along fetal trunk. ~70%
• Flexed breech: Legs are flexed at the hips and the knees
  with fetus sitting on its legs.
• Knee or footling presentation: One or both legs are flexed and breech; baby is above the pelvis.

This presentation may be critical as it may lead to entrapment of the head and prolapsed limb or cord.

§ Hazards of breech presentation includes cord compression and prolapse,

entrapment of the head behind the cervix specially during footling presentation, intracranial hemorrhage and trauma to viscera; rupture of gut and spleen specially if obstetrician handles the fetal abdomen

Question 4

Management of breech presentation

Answer 4

• Best option is to avoid vaginal breech delivery. Caesarian section is the safest!
• Performance of External Cephalic Version (ECV) at 38 weeks ~50% efficient;

pressure is applied in opposite direction to the two fetal poles as the mother sits
in a supine position. Assisted by ultrasound and CTG.

• ECV may lead to placental abruption, rupture of membrane and fetal bradycardia
  (urgent!).
• Müller maneuver- the arm close to the symphysis is released/extracted.
• Classical arm extraction- arm close to perineum is extracted.
• Mauricaeu maneuver.
• Bracht maneuver

Question 5

Criteria for vaginal delivery are

Answer 5

Fetal weight more than 1.5 kg, less than 4 kg.
- Flexed or frank breech presentation, flexed head, and impeccable CTG