Breech Presentation

Subject: Midwifery II (Theory)

Overview

It is the most prevalent malpresentation after 34 weeks of gestation, though the presentation may vary after 36 weeks. In breech presentation, the sacrum is the presenting component. The fetus is lying longitudinally in the lower pole of the uterus, with a bitrochanic (10cm) exhibiting diameter and sacrum as the denominator. Breach presentation can be caused by a flaw in the passenger, a fault in the passage, or a recurring or habitual breech. Management during the antenatal period comprises identifying complicating variables associated with breech presentation, external cephalic version if not contraindicated, and development of the line management if the version fails or is contraindicated. Breech with extended or convoluted breech has a greater risk of early membrane rupture.

After 34 weeks of gestation, it is the most prevalent malpresentation; however, the presentation may change after 36 weeks. The sacrum is the presenting component in breech presentation. The fetus is located longitudinally in the lower pole of the uterus, with a bitrochanic (10cm) exhibiting diameter and sacrum as the denominator.

There is an exception to universal flexion and extension of legs in the breech presentation. In an anterior posture, the sacrum is directed toward the iliopubic eminence, while in a posterior position, the sacrum is directed towards the Sacro-iliac joints. This appearance occurs in roughly 3% of term and mid-trimester pregnancies.

Causes

  • Fault in the passenger
  • Fault in the passage
  • Others: recurrent or habitual breech

 Diagnosis

  • Palpation
  • Auscultation
  • Ultrasound examination
  • X-ray examination
  • Vaginal examination

Management

Antenatal management

  • Identifying the aggravating variables associated with breech presentation
  • If not contraindicated, an external cephalic version
  • If the version fails or is contraindicated, line management is formed.

Management if the version fails or contraindicated

  • Cesarean section
  • Allow for spontaneous vaginal birth.

Management during labor

During 1st stage

  • The basic treatment during this period is the same as it is during regular labor.
  • Breech with prolonged or other difficult breech may have a significant risk of early membrane rupture and cord prolapse, hence a PV exam should be performed as soon as the membrane ruptures.

During 2nd stage

  • As the second stage of labor begins, notify your obstetrician and pediatrician.
  • Failure to descend despite enough uterine contractions indicates the need for a cesarean section.
  • The type of birth is determined by the type of breech and the maternal state. Breech delivery is classified into three types:
    - Spontaneous vaginal breech delivery
    - Assisted breech delivery
  • Breech extraction

References

  • emedicine.medscape.com/article/262159-overview
  • americanpregnancy.org › Labor and Birth
  • https://familydoctor.org › Family Health › Pregnancy and Childbirth
  • www.webmd.com/baby/tc/breech-position-and-breech-birth-topic-overview
  • patient.info/doctor/breech-presentations
  • Pathak, Sumita and Sochana Sapkota. A Textbook of Leadership and Management. Bhotahity, Kathmandu: Vidyarthi Pustak Bhandar, 2014
     
Things to remember
  • After 34 weeks of gestation, it is the most prevalent malpresentation; however, the presentation may change after 36 weeks. The sacrum is the presenting component in breech presentation.
  • The fetus is located longitudinally in the lower pole of the uterus, with a bitrochanic (10cm) exhibiting diameter and sacrum as the denominator.
  • Breech presentation is caused by a fault in the passenger, a fault in the passage, and others: recurrent or habitual breach.
  • Identifying complicating variables associated with breech presentation, external cephalic version if not contraindicated, and construction of the line management, if the version fails or is contraindicated, are all part of prenatal care.
  • Workforce management Breech with prolonged or other difficult breaches may have a significant risk of early membrane rupture and cord prolapse, hence a PV exam should be performed as soon as the membrane ruptures.
  • The type of birth is determined by the type of breech and the maternal state.
  • Breech delivery is classified into three types: spontaneous vaginal breech delivery, assisted breech delivery, and breech extraction.
Questions and Answers

After 34 weeks of gestation, it is the most typical malpresentation; occasionally, the presentation can change after 36 weeks. The sacrum is the presenting component in breech presentation. The sacrum serves as the denominator, and the sacrum's presenting diameter is bitrochanic (10 cm), with the fetus lying longitudinally in the lower pole of the uterus.

Management

  • Antenatal Management
    • Identification of the complicating factors related with breech presentation.
    • External cephalic version ; if not contraindicated.
    • Formation of the line management, if the version fails or is contraindicated.
  • Management if version fails or contraindicated
    • Caesarean section.
    • Allow spontaneous vaginal delivery occur.
  • Management During Labour
    • During 1st stage.
    • Basic care during this stage is same as in normal labour.
    • Breech with extended and other complicated breech may have high chance of early membrane rupture and there is possibility of cord prolapse so PV exam must do as soon as membrane rupture.

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