Definition : fetal buttocks is the presenting part Incidence : occurs in 3-4% of pregnancies at term (25% before 28 weeks) Classifi...
Definition : fetal buttocks is the presenting part
Incidence : occurs in 3-4% of pregnancies at term (25% before 28 weeks)
Classification
- complete: flexion at hips and knees
- frank: flexion at hips, extension at knees
- most common type of breech presentation
- only breech presentation delivered vaginally
- footling: may be single or double with extension at hip(s) and knee(s) so that foot is the presenting part
complete ( flexed )
Frank Breech (Extended )
Footling Breech
Etiology Maternal
- pelvis (contracted)
- uterus (shape abnormalities, intrauterine tumours, fibroids,extrauterine tumours causing compression)
- grand multiparity
Fetal
- prematurity
- multiple gestation
- congenital malformations (found in 6% of breeches; 2-3 x the incidence in vertex prese
Maternal-Fetal
- placenta (previa)
- amniotic fluid (poly/oligohydramnios)
Leopold maneuvers and U/S
Management
Extenal Cephalic version
- criteria: > 37 weeks, singleton, unengaged presenting part,reactive NST
- contraindications: previous T3 bleed, prior classical C-section, previous myomectomy, oligohydramnios, PROM,placenta previa, abnormal U/S, suspected IUGR
- risks: abruption, cord compression
- method: tocolysis, followed by transabdominal manipulation of fetus, guided by ultrasound
- if patient Rh negative Rhogam given prior to procedure
Good prognostic factors (for a successful version)
- multiparous
- good fluid volume
- small baby
- skilled obstetrician
- frank breech, GA > 36 weeks
- EBW 2200-3800 g based on clinical and U/S assessment
- fetal head flexed
- continuous fetal monitoring
- maternal pelvis adequately large (clinically, or ìprovenî by previous delivery)
- no other indication for C/S
- experienced obstetrician C-section for all other presentations (except mentoanterior face presentation)
