Breech presentation

Август 3, 2022

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Breech presentation

Содержание

2. The definition of breech presentation is when the buttocks, foot or feet are presenting instead of
3. classifications Frank breech where the hips are flexed and legs extended Complete breech where the hips
5. Associations and Causes
6. Maternal factors Polyhydraminos Uterine anomalies (bicornuate, septate) Space occupying lesions (e.g fibroids) Placental abnormalities (praevia, cornual)
7. Fetal factors Prematurity Fetal anomalies (e.g neurological, hydrocephalus, anenecephaly) Multiple pregnancy Fetal death Short umbilical cord
8. The incidence of breech presentation decreases from about 20% at 28 weeks of gestation to 3–4%
9. What information should be given to women with breech presentation regarding mode of delivery?
10. Term Breech Trial 2000 trials with 2396 participant Caesarean delivery 1060/1169 (91%) of those women allocated
11. Perinatal or neonatal death(excluding fatal anomalies) or short-term neonatal morbidity was reduced with a policy of
12. After excluding ,perinatal mortality, neonatal mortality or serious neonatal morbidity with planned caesarean section compared with
13. adverse perinatal outcome was lowest with prelabour caesarean section and increased with caesarean section in labour
14. In the latter study, of the 2526 women with planned vaginal deliveries, 1796 delivered vaginally (71%)
15. death or neurodevelopmental delayat age 2 years, was similar between the two groups.
16. Summary of TBT lower rates of perinatal and neonatal death lower rates of short term neonatal
17. What factors affect the safety of vaginal breech delivery should be assessed carefully before selection for
18. unfavourable for vaginal breech birth ● other contraindications to vaginal birth (e.g. placenta praevia, compromised fetal
19. Intrapartum management should take place in a hospital with facilities for emergency caesarean section Labour induction
20. Epidural analgesia should not be routinely advised; women should have a choice of analgesia during breech
21. Continous electronic fetal heart rate monitoring should be offered to women with a breech presentation in
22. Caesarean section should be considered if there is delay in the descent of the breech at
23. Three types of vaginal breech deliveries Spontaneous breech delivery Assisted breech delivery Total breech extraction
24. Total breech extraction only with 2nd non vextex twin delivery procedure in which the infant's feet
25. ECV External cephalic version (ECV) is the transabdominal manual rotation of the fetus into a cephalic
27. contraindication to ECV preterm Multiple pregnancy significant third trimester bleeding IUGR, oligohydramnion PROM PIH nonreassuring foetal
28. Risk of ECV umbilical cord entanglement abruptio placenta premature rupture of the membranes (PROM) severe maternal
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The definition of breech presentation is when the buttocks, foot or

feet are presenting instead of the head

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classifications
Frank breech where the hips are flexed and legs extended

Complete breech where the hips and knees are flexed and the feet are not below the level of the fetal buttocks
Footling breech where one or both feet are presenting as the lowest part of the fetus

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Associations and Causes

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Maternal factors
Polyhydraminos
Uterine anomalies (bicornuate, septate)
Space occupying lesions (e.g fibroids)

Placental abnormalities (praevia, cornual)
Multiparity (in particular grand multips)

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Fetal factors
Prematurity
Fetal anomalies (e.g neurological, hydrocephalus, anenecephaly)
Multiple pregnancy
Fetal death
Short

umbilical cord

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The incidence of breech presentation decreases from about 20% at 28

weeks of gestation to 3–4% at term, as most babies turn spontaneously to the cephalic presentation

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What information should be given to women with breech presentation

regarding mode of
delivery?

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Term Breech Trial 2000
trials with 2396 participant
Caesarean delivery 1060/1169 (91%)

of those women allocated to planned caesarean section
550/1227 (45%) of allocated to a vaginal delivery protocol

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Perinatal or neonatal death(excluding fatal anomalies) or short-term neonatal morbidity was

reduced with a policy of planned CS(RR 0.33, 95% CI 0.19–0.56) and perinatal or neonatal death alone (excluding fatal anomalies) was reduced with a policy of planned caesarean section (RR 0.29, 95% CI 0.10–0.86)

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After excluding ,perinatal mortality, neonatal mortality or serious neonatal morbidity with

planned caesarean section compared with planned vaginal birth was 16/1006 (1.6%) compared with 23/704 (3.3%) (RR 0.49; CI 0.26–0.91); P = 0.02).

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adverse perinatal outcome was lowest with prelabour caesarean section and

increased with caesarean section in labour

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In the latter study, of the 2526 women with planned vaginal

deliveries, 1796 delivered vaginally (71%)
The rate of neonatal morbidity or death was considerably lower than the 5% in the Term Breech Trial (1.60%; 95% CI 1.14–2.17), and not significantly different from the planned caesarean section group

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death or neurodevelopmental delayat age 2 years, was similar between the

two groups.

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Summary of TBT
lower rates of perinatal and neonatal death

lower rates of short term neonatal morbidity or perinatal death
fewer 5 minutes Apgar scores <7
lower risk of adverse perinatal outcomes
small increase in the short term maternal morbidity

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What factors affect the safety of vaginal breech delivery

should

be assessed carefully before selection for vaginal breech birth

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unfavourable for vaginal breech birth
● other contraindications to vaginal birth (e.g.

placenta praevia, compromised fetal condition)
● clinically inadequate pelvis
● footling or kneeling breech presentation
● large baby (usually defined as larger than 3800 g)
● growth-restricted baby (usually defined as smaller than 2000 g)
● Hyperextended fetal neck in labour (diagnosed with ultrasound or X-ray where ultrasound is not available)
● lack of presence of a clinician trained in vaginal breech delivery
● previous caesarean section.

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Intrapartum management
should take place in a hospital with facilities for emergency

caesarean section
Labour induction for breech presentation may be considered if individual circumstances are favourable
Labour augmentation is not recommended

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Epidural analgesia should not be routinely advised; women should have a

choice of analgesia during breech labour and birth.

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Continous electronic fetal heart rate monitoring should be offered to women

with a breech presentation in labour.
Fetal blood sampling from the buttocks during labour is not advised.

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Caesarean section should be considered if there is delay in the

descent of the breech at any stage in the second stage of labour.
Episiotomy should be performed when indicated to facilitate delivery.

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Three types of vaginal breech deliveries
Spontaneous breech delivery
Assisted breech delivery
Total

breech extraction

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Total breech extraction
only with 2nd non vextex twin delivery
procedure in

which the infant's feet are grasped by the operator and the fetus is extracted from the uterine cavity through the vagina.

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ECV
External cephalic version (ECV) is the transabdominal manual rotation of the

fetus into a cephalic presentation.
after ECV successful rate 35-86%
breech presentation at term, after ECV 1 - 1.5%
indications for urgent caesarean after ECV 1 - 3%
The risk of intrauterine death of foetus after ECV is about 0.0001%

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contraindication to ECV
preterm
Multiple pregnancy
significant third trimester bleeding
IUGR,
oligohydramnion
PROM

PIH
nonreassuring foetal monitoring patterns
all contraindications to vaginal birth are concerned to execute ECV

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Risk of ECV
umbilical cord entanglement
abruptio placenta
premature rupture of the membranes

(PROM)
severe maternal discomfort

Breech presentation

Содержание

The definition of breech presentation is when the buttocks, foot or

classifications Frank breech where the hips are flexed and legs extended

Associations and Causes

Maternal factors Polyhydraminos Uterine anomalies (bicornuate, septate)Space occupying lesions (e.g fibroids)

Fetal factors PrematurityFetal anomalies (e.g neurological, hydrocephalus, anenecephaly) Multiple pregnancyFetal deathShort

The incidence of breech presentation decreases from about 20% at 28

What information should be given to women with breech presentation

Term Breech Trial 2000 trials with 2396 participantCaesarean delivery 1060/1169 (91%)

Perinatal or neonatal death(excluding fatal anomalies) or short-term neonatal morbidity was

After excluding ,perinatal mortality, neonatal mortality or serious neonatal morbidity with

adverse perinatal outcome was lowest with prelabour caesarean section and

In the latter study, of the 2526 women with planned vaginal

death or neurodevelopmental delayat age 2 years, was similar between the

Summary of TBT lower rates of perinatal and neonatal death

What factors affect the safety of vaginal breech delivery should

unfavourable for vaginal breech birth● other contraindications to vaginal birth (e.g.

Intrapartum managementshould take place in a hospital with facilities for emergency