Breech Presentation Final
Chapter 48: Breech Delivery Techniques
Dr. Ernesto S. Uichanco
Introduction
Classification of Breech Presentation
Vaginal Delivery Versus Cesarean Section
Management of Labor and Delivery Spontaneous Breech Delivery Assisted Breech Delivery Delivery of the Shoulder and Arms Delivery of the Head Mauriceau-Smellie-Voit Maneuver Piper’s Forceps Application Complete Breech Extraction Cesarean Section
Difficulties in Vaginal Breech Delivery Nuchal Arm Cervical Entrapment of the Head Malposition of the Head
External Cephalic Version
Symphysiotomy
Conclusion
The management of breech presentation represents an excellent example of a group of difficult and uncertain therapeutic choices facing the obstetrician in current practice. For many decades, the vaginal delivery of a breech presenting fetus was regarded as an obstetric art. The skill of an obstetrician could be judged by the elegance and efficiency in the conduct of such deliveries. During the last 100 years the management of breech presentation has been undergoing dramatic changes, and will probably continue to remain so in the next half century.
Classification of Breech Presentation
Breech presentation occurs in 3.5 to 4.0% of all singletons in labor. When multiple pregnancies are included, the incidence of breech presentation rises to 4.4 to 5.2%. The earlier in gestation, the higher is its incidence. The great majority though, converting to cephalic presentation by the 34th week.
The risk of recurrent breech presentation is more than threefold, resulting in a 10 to 12% incidence in term pregnancies after prior breech delivery.
There are three major types of breech presentation:
1. Frank breech: Hips are flexed on the abdomen and knees are extended.
2. Complete breech: Hips and knees are flexed and the buttocks and knees are at the same level.
3. Incomplete breech: One or both hips are extended so that one or both feet and/or knees are below the level of the
Dr. Ernesto S. Uichanco
Introduction
Classification of Breech Presentation
Vaginal Delivery Versus Cesarean Section
Management of Labor and Delivery Spontaneous Breech Delivery Assisted Breech Delivery Delivery of the Shoulder and Arms Delivery of the Head Mauriceau-Smellie-Voit Maneuver Piper’s Forceps Application Complete Breech Extraction Cesarean Section
Difficulties in Vaginal Breech Delivery Nuchal Arm Cervical Entrapment of the Head Malposition of the Head
External Cephalic Version
Symphysiotomy
Conclusion
The management of breech presentation represents an excellent example of a group of difficult and uncertain therapeutic choices facing the obstetrician in current practice. For many decades, the vaginal delivery of a breech presenting fetus was regarded as an obstetric art. The skill of an obstetrician could be judged by the elegance and efficiency in the conduct of such deliveries. During the last 100 years the management of breech presentation has been undergoing dramatic changes, and will probably continue to remain so in the next half century.
Classification of Breech Presentation
Breech presentation occurs in 3.5 to 4.0% of all singletons in labor. When multiple pregnancies are included, the incidence of breech presentation rises to 4.4 to 5.2%. The earlier in gestation, the higher is its incidence. The great majority though, converting to cephalic presentation by the 34th week.
The risk of recurrent breech presentation is more than threefold, resulting in a 10 to 12% incidence in term pregnancies after prior breech delivery.
There are three major types of breech presentation:
1. Frank breech: Hips are flexed on the abdomen and knees are extended.
2. Complete breech: Hips and knees are flexed and the buttocks and knees are at the same level.
3. Incomplete breech: One or both hips are extended so that one or both feet and/or knees are below the level of the
References: Hellston C, Lindqvist P, Olofsson P. Vaginal breech delivery: is it still an option?. Eu J Obstet Gynecol Rep Biol. 111 (2003):122-128.