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Breech Presentation. Incidence. 3-4% of fetus present by breech at term 7% at 32 weeks 25% at 28 weeks 20% diagnosed in labour. External Cephalic Version. Best evidence states that ECV should be offered late in pregnancy Success rate increased with: multiparity adequate liquor

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Presentation Transcript
incidence
Incidence
  • 3-4% of fetus present by breech at term
  • 7% at 32 weeks
  • 25% at 28 weeks
  • 20% diagnosed in labour
external cephalic version
External Cephalic Version
  • Best evidence states that ECV should be offered late in pregnancy
  • Success rate increased with:
    • multiparity
    • adequate liquor
    • station of breech above the pelvic brim
types of breech
Types of Breech

Frank Complete Footling

breech delivery
Breech Delivery

The essence of the vaginal breech delivery is allowing as much spontaneous delivery by uterine action and maternal effort as possible

Operator intervention should be limited to

the following manoeuvres

breech delivery2
Breech Delivery

The cervix should be fully dilated and the fetal anus visible on the perineum for active second stage.

breech delivery3
Breech Delivery

Consider lithotomy position.

breech delivery4
Breech Delivery

Delivery of the breech should be ‘hands off’

Legs and abdomen are born spontaneously.

breech delivery5
Breech Delivery

Ensure that the fetal back rotates uppermost by carefully grasping the fetal pelvis with fingers & thumbs.

Leg delivery may need knee flexion by pressure in popliteal fossa

breech delivery6
Breech Delivery

The fetus should be allowed to hang once the legs and abdomen have emerged until the wings of the scapula are seen.

lovset s manoeuvre
Lovset’s Manoeuvre

Grasp the fetus around the bony pelvis with the thumbs across the sacrum.

The fetal back should then be turned through 180 degrees until the posterior arm comes to lie anteriorly…….

lovset s manoeuvre1
Lovset’s Manoeuvre

The elbow will appear below the symphysis pubis and the arm is delivered by sweeping it across the fetal body.

The manoeuvre is repeated in reverse to deliver the other arm.

breech delivery7
Breech Delivery

Allow the fetus to hang from the vulva until the nape of the neck is visible.

Then carry out Mauriceau-Smellie-Veit manoeuvre