Breech Presentation 1

BREECH PRESENTATION BY

DR ROSEMARY OGU DEPT OF OBSTETRICS AND GYNAECOLOGY UPTH

OUTLINE  DEFINITION  INCIDENCE  TYPES

OF BREECH PRESENTATION  AETIOLOGICAL FACTORS  CLINICAL FEATURES  CLINICAL IMPORTANCE OF BREECH PRESENTATION

DEFINITION  Breech

presentation is a type of malpresentation i.e a fetal presentation other than vertex.  The breech is said to present when either the buttock or foot or feet of the fetus occupies the lower uterine pole.

INCIDENCE  Varies

with gestational age  30-40% @ 20-25 weeks  25% @ 28-30 weeks  16% @ 32 weeks  3-4 % @ term  Up to 33% are undiagnosed until labour  UPTH 3.2% at term.

TYPES  This

is based on the attitude of fetal lower limbs and the breech in the lower uterine pole. [Attitude is the relationship of the various parts of the fetus to one another]  Frank or extended breech  Complete or flexed breech  Incomplete or footling breech

FRANK OR EXTENDED BREECH  Both

lower limbs are extended at the knee and flexed at the hip  ~ 50-65 % of all breech presentation  Commonest in primigravidae

COMPLETE OR FLEXED BREECH  Both

lower limbs are flexed at the knee and at the hip  Both feet and buttocks occupy the lower segment  10-15 % of all breech presentation

INCOMPLETE OR FOOTLING BREECH  One

or both hips extended and one or both feet occupy the lower pole  Seen in multiparous women  ~ 25-35 % of all breech presentation

AETIOLOGICAL FACTORS  Fetal

prematurity  Fetal anomalies CNS

malformations eg hydrocephalus Neck masses aneuploidy  Abnormal -praevia

 Multiply

placental position

or cornual

pregnancies  Oligo or poly hydramious

AETIOLOGICAL FACTORS  Uterine

abnormalities;

Malformations Fibroids

 Abnormally

shaped pelvic brim  Pelvic tumors

CLINICAL FEATURES  Incidental

finding during routine clinical examination  Complaints of epigastric or subcostal discomfort  Fetal movement felt in the pelvis

COMPLICATIONS OF BREECH PRESENTATION FETAL  Greater risk of perinatal & neonatal mortality and neonatal morbidity  Risk of death; intrapartum - 10 fold higher  Term breech fetuses delivered by vaginal route had 9 fold risk of PM  Generally 2-4 fold risk of death

COMPLICATIONS CONTD  Cord

prolapse  Intra cranial haemorrhage  Skeletal injuries; shoulder, cervical spine and hip joint dislocation, clavicular, humeral and femoral fractures.  Soft tissue injuries, ruptured viscous  Nerve injuries-klumpke’s palsy, Erb’s palsy  Birth asphyxia

COMPLICATIONS CONTINUED Maternal Vaginal breech delivery is associated with less risk to the mother compared to caesarean section.  Perineal tears  Vaginal

lacerations

 Para-vaginal  Cervical

haematoma

laceration. These can occur in difficult assisted vaginal breech delivery.

COMPLICATIONS CONTINUED  At

Caesarean Section

Anaesthetic

risk Haemorrhage Increased need for blood transfusion  Post

operative morbidity

Pain Fever Sepsis Deep

vein thrombosis

THANK YOU !