Breech Presentation

GLOCAL UNIVERSITY
GLOCAL COLLEGE OF NURSING & RESEARCH

CENTRE
SUBMITTED BY: Ms. RONIKA

(NURSING TIUTOR)
MAIL ID: [email protected]
PRINCIPAL: Mr.Himanshu Massey

MAIL ID: [email protected]
COURSE: GNM
YEAR: 3 rd
SUBJECT: MIDWIFERY
TOPIC:
BREECH PRESENTATION
MALPRESENTATIONS: all presentations of the
fetus other than the vertex are called as
malpresentations.
Common malpresentations are:
1)breech presentation(common most
malpresentation)
2)face presentation
3)brow presentation
4)transverse lie
5)shoulder presentation
BREECH PRESENTATION
It is a type of malpresentation in which, the
podalic pole (fetal buttocks or the lower
extremity) presents at the pelvic inlet and the
denominator is sacrum. The lie is longitudinal.
It is the commonest malpresentation.
INCIDENCE:
Around 3–5% of pregnant women at term (37–40
weeks pregnant) have a breech baby.Due to their
higher than average rate of possible complications
for the baby, breech births are generally considered
higher risk.
VARIETIES OF BREECH:
1)complete breech(flexed breech): in this, the hips and
knees are flexed and the feet are present on the pelvis. It
is more common in multigravida.
2)incomplete breech: there is incomplete flexion with
extension at one or two joint
Types are:
a)breech with extended legs(frank breech): in this,
the hip joint is flexed and knee joints are extended. The
external genitalia and buttocks are the presenting part. It
is more common in primigravida due to extension of legs
from well supported abdominal muscles.
b)footling presentation: both the thighs and legs are
partially extended bringing the legs to present at the
brim.
c)knee presentation: thighs are extended but the

knees are flexed.
CLINICAL VARIETIES:
1)complicated: when the presentation is associated
with the complications such as prematurity, twins,
contracted pelvis, placenta praevia etc.
2)uncomplicated: when there is no other complication
associated with the breech.
ETIOLOGY OF BREECH PRESENTATION:
Maternal factors:
• Multiparity
• Uterine obliquity
• Placenta praevia
• Uterine anomalies
• Uterine fibroids
• Contracted pelvis
• Hydramnios
• Previous breech delivery
•
Fetal causes:
• Prematurity
• Multiple pregnancy
• Hydrocephalus
• Intrauterine fetal death
• Extended legs
Half of the cases are due to unknown cause.

DIAGNOSIS:
1)history collection
2)physical examination
Abdominal findings:
• The hard, round, ballotable head is found occupying
the fundus.
• The buttocks and extremities are felt on the lower
part of the abdomen near umbilicus.
• FHS is felt above the umbilicus.
Pelvic examination: head not felt in the pelvis
3)Ultrasonography
MECHANISM OF LABOUR:
In the mechanism of breech delivery, the principle
movements occur at three places:
buttocks, shoulders and head.
1) Buttocks: the diameter of engagement of the

buttock is one of the oblique diameters of the inlet.
The engaging diameter id bitronchetric (10cm) with
the sacrum directed towards the ilio-pubic eminence.
When the diameter passed through the pelvic brim,
the breech is engaged.
• Descent of the buttocks: until the anterior buttock
touches the pelvic floor.
• internal rotation of the anterior buttock: occurs
through 1/8th of the circle placing it behind the
symphysis pubis.
• further descent with lateral flexion: descent with the
lateral flexion of the trunk occurs until the anterior hip
hinges under the symphysis pubis which is released
first followed by posterior hip.
• delivery of the trunk occurs and the lower limb
follows.
• restitution occurs so that the buttocks occupy the
original position as during engagement in oblique
diameter.
2) Shoulder:
• bisacromial diameter(12cm)engages in the same oblique
diameter as that occupied by the buttocks at the brim after
the delivery of the breech.
• Descent occurs with the internal rotation of the shoulders
bringing shoulder to lie in the anterior posterior diameter of
the pelvic outlet. The trunk simultaneously rotates through
1/8th of the circle.
• Delivery of the posterior shoulder followed by the anterior
one is completed by anterior flexion of the delivered trunk.
• Restitution and external rotation: untwisting of the trunk
occurs. External rotation of the shoulders occurs to the same
direction because internal rotation of acciput through 1/8th of
a circle anteriorly. The fetal trunk is now positioned as dorso
anterior.
3) Head:
• Engagement occurs either through the opposite oblique
diameter as that occupied by the buttocks or through the
transverse diameter. The engaging diameter of the head is
suboccipito frontal(10 cm)
• Descent with increasing flexion occurs.
• Internal rotation of the occiput occurs anteriorly, through
1/8th or 2/8th of the circle placing the occiput behind the
symphysis pubis.
• Further descent until the sub occiput hinges under the
symphysis pubis.
• the head is born by flexion.
Assisted breech delivery:
• Breech delivery should be conducted by a skilled
obstetrician.
• Principles in conduction:
• Never rush
• Never pull from below but push from above
• Always keep the fetus with the back anteriorly
Steps :
• The patient is brought to the table when the anterior buttock and fetal anus are
visible. She is placed in lithotomy position.
• Antiseptic cleaning ism done
• Episiotomy is given
• Woman now is allowed to gradually bear down efforts till buttocks and legs are
delivered up to the level of umbilicus. No manipulation is performed and only
perineum is supported. Infact the fetus is not touched till the delivery of the
umbilicus.
• After the delivery of the breech upto umbilicus, the following steps are followed:
• Wrap the baby in warm towel(savage’s maneuver). This reduces the vasospasm of
the umbilical vessels due to atmospheric temperature.
• Once the fetal body is delivered upto umbilicus, push the cord to one side to
minimize the traction and compression if it is caught between the fetal body or the
head and pelvic wall.
• The extended legs(in frank) are to be delivered by pressure on the knees in a
manner of abduction and flexion of the thighs. .
• The obstetrician should hold the baby by the femoro-pelvic grip with the
operator’s fingers on the fetal pelvis and the thumb being on the sacro iliac
regions. A gentle traction should be given during the uterine contractions and
pressure should never be applied to the fetal abdomen to avoid the injuries.
• Delivery of shoulder & arms: using the femoro pelvic
grip, the trunk can be rotated and the shoulders will
occupy antero posterior diameter of the pelvic inlet.
Either shoulder can be delivered depending upon the
convenience.
• Delivery of the aftercoming head: this is the most
important stage of the delivery. Not more than 10
minutes (preferably 5 minutes) should elapse
between the delivery of umbilicus and head to
reduce the chance of fetal asphyxia.
There are various effective and safe methods of the
delivery of the fetal head:
Burn Marshall method: it is the most commonly used method.
This method is applicable when both arms have been delivered
and then patient is in lithotomy position.
• The fetus is allowed to hang by its own weight completely
unsupported. The assistant gives the suprapubic pressure with
every contraction in downward and backward direction to assist
in engagement of the fetal head until the delivery of the head.
• The obstetrician should sit with lap under the baby in case bay
tries to fall on the ground.
• The obstetrician takes the fetus’ legs in right hand, placing the
middle finger between the both ankles and lifts the infant
towards the mother’s abdomen by swinging in an arc.
• The head is extracted by traction on the infant’s feet, swinging
them slowly outwards and then upwards which causes the
flexion head helping in its delivery.
BIBLIOGRAPHY:
1) DC Dutta “A Textbook of Obstetrics”
Published By: New Central Book Agency;
Edition : 7th ; Page Referred: 374-376
2) JB SHARMA “ Midwifery and Gynaecological Nursing”
Published By: Avichal Publishing Company; Edition:
3rd; Page Referred: 409-411
3) https://en.wikipedia.org/wiki/Breech_birth
THANKYOU

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GLOCAL UNIVERSITY

GLOCAL COLLEGE OF NURSING & RESEARCH

SUBMITTED BY: Ms. RONIKA

PRINCIPAL: Mr.Himanshu Massey

c)knee presentation: thighs are extended but the

Half of the cases are due to unknown cause.

1) Buttocks: the diameter of engagement of the

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