Teacher: Kamilova Irina Kaharovna Prepared By: Sulur PerumalSwamy Venkatesh

Kamilova Irina Kaharovna Prepared By: Sulur PerumalSwamy Venkatesh Prabhu Group: LA-1-CO-163(B) Course:

5 Date: 30-09-2020 Year: 2020-2021 Batch

encountered malpresentation in pregnancy is breech presentation
Breech means that your

baby is lying bottom first or feet first in the womb (uterus) instead of in the usual head first position. As pregnancy continues, a baby usually turns naturally into the head first position.

32 weeks
25% of pregnancies of less than 28 weeks’

the baby is bottom first, with the thighs against the

chest and feet up by the ears. Most breech babies are in this position (most common)

Flexed breech – the baby is bottom first, with the thighs against the chest and the knees bent

Footing breech – the baby’s foot or feet are below the bottom

A BREECH BABY MAY BE LYING IN ONE OF THE FOLLOWING POSITIONS

chance that a baby does not turn and remains the

breech position. At other times, certain factors make it difficult for a baby to turn during pregnancy. These might include the amount of fluid in the womb (either too much or too little), the position of placenta or if there’s any more than one baby in the womb.

The vast majority of breech babies are born healthy. For a few babies, breech may be a sign of a problem with the baby

anencephaly or hydrocephalus
Fetal neuromuscular condition
Oligohydramnios
Polyhydramnios

examination
Confirmed by ultrasound
If breech presentation is clinically suspected at or

after 36 weeks, this should be confirmed by ultrasound scan. The scan should document fetal biometry, amniotic fluid volume, placental site and position of fetal legs. The scan should also look for any anomalies previously undetected.

the breech is felt, with its characters.

Auscultation
The fetal heart sounds

are head just at, or above the level of the umbilicus

Slow dilatation of cervix
After rupture of the membranes, the presenting part is felt that is , the two buttocks with the anus in between , the genitalia on one side and the sacral spines on the opposite side.
In case of complete breech, the feet are felt on the same level as the buttocks.
In case of breech with extended legs, the buttocks only are felt.
In case of footling presentation, the feet are at a lower level than the buttocks.
In case of knee presentation, the knees are a lower level than the buttocks.

ABDOMINAL EXAMINATION

VAGINAL EXAMINATION

and has been shown to reduce the number of Caesarean

sections due to breech presentations.
Should be offered at 36-37 weeks of pregnancy.
Success rate is around 50 per cent and are higher in multiparous women who tend to have more lax abdominal musculature. However it depends on the experience of the obstetrician.
A fetal heart rate trace must be performed before and after the procedure.
It is important to administer anti-D if the woman is Rhesus- negative.

completed weeks by an experienced obstetrician.
ECV should be performed with

tocolytics (e.g. nifedipine) as this has been shown to improve the success rate.
The woman is laid flat with a left lateral tilt having ensured that she has emptied her bladder and is comfortable.
HOW IS IT DONE?
With ultrasound guidance the breech is elevated from the pelvis and one hand is
used to manipulate this upward in the direction of a forward role, while the other hand applies gentle pressure to flex the fetal head and bring it down to the maternal pelvis.

bradycardia

Caesarean or myomectomy scar on the uterus
Multiple gestation
Pre-eclampsia or hypertension
Plan

to deliver by Caesarean section anyway

Caesarian or Vaginal Breech Delivery (lower the risk of going

to LSCS).

If fails, about 3% will turn to spontaneous delivery
Placental Abruption
Umbilical Cord Entanglement
Premature Rupture of Membrane
Severe maternal discomfort
Fetal bradycardia and non-reactive CTG
Alteration in umbilical artery and mid cerebral artery waveform
Increase in Amniotic Fluid Volume

3.5 kg
No evidence of hyperextension of fetal head and fetal

abnormalities (hydrocephalus)
No other obstetric complications.

monitored
Epidural administration can prevent pushing before full dilatation
Fetal blood sampling to

monitor acid base status
Operator experienced in delivering breech babies should be available.

the pelvic floor. ( naturally )

Internal rotation of the anterior

buttock occurs through 1/8th of a circle placing it behind the symphysis pubis.

Further descent with lateral flexion of the trunk occurs until the anterior hip hinges under the symphysis pubis which is released first followed by the posterior hip.

Legs are flexed (deliver spontaneously)
Legs are extended, (deliver
using pinard’s manoeuvre)
Using a fingers to flex the leg at the knee and then extend the hip
With contractions and maternal
effort, lower body will delivered

1. Delivery of the buttocks

2. Delivery of the legs and

lower body

transverse diameter of the pelvic mid cavity
Descent occurs with internal

rotation of the shoulders bringing the shoulders to lie in the antero-posterior diameter of the pelvic outlet.
Finger will gently above the shoulder
Posterior arm/ shoulder reaches the
pelvic floor, it will rotate anteriorly
Once the spine become visible, delivery of the second arm will follow
Loveset’s manoeuvre .

obstetrician arm with downward traction being levelled on the head

via finger in the mouth and one on each maxilla

If difficult, forceps need to be applied

baby will
get ‘stuck’.

Interference in the natural process by the inappropriate

use of oxytoxic agents or by trying to pull the baby out (breech extraction) will (paradoxically) increase the obstruction occuring.

When delay occurs, particularly with delivery of the shoulders or head, the presence of an experienced obstetrician will reduce the risk of death or serious injury.

Breech presentation should go for C-Sect
“Planned C-sect is safe for

singleton term breech babies than planned vaginal birth, managed accordingly to a clinical protocol, but more complications for mothers.”
The review of the this study showed that Planned C-sect was safer for the singleton breech baby at term than planned VBD.

as larger than 3800 g)
Growth-restricted baby (usually defined as smaller

than 2000 g)
Hyperextended fetal neck in labour
Previous caesarean section.
Delay in the descent of the breech at any stage in the second stage of labour.
Other contraindications to vaginal birth
– placenta praevia, compromised fetal condition