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Breech presentation

The incidence of breech varies according to gestation and is 40% at 20 weeks of gestation ,6-8% at34 weeks and 3-4% at term.                                                                                                           Aetiology:                                                                                                                                           

-prematurity.                                                                                                                                  

-multiparity.                                                                                                                                    

-hydramnios.                                                                                                                                 

-congenital anomalies of the uterus.                                                                                           

-fetal anomalies: hydrocephaly,anencephaly.                                                                         

-previous breech delivery.                                                                                                            

-placental causes :placenta previa favours breech presentation.                                      

Types of breech:                                                                                                                     

-Extended breech or frank breech.                                                                            

-Flexed breech or complete breech.                                                                         

Footling or knee presentation.                                                                               

Diagnosis:                                                                                                             

History:                                                                                                          

Examination:    General,abdominal andpelvic exam.                                                                                                         

Investigations;                                                                                      

Management Options in breech presentation:                                                          

Antenatal management:                                                                           

Increased perinatal mortality and morbidity with breech presentation is well recognized .The follow up during pregnancy as any pregnancy providing recognition of the risk factors waiting for spontaneous version to develop ,if not soone of the options is to do;                   

External Cephalic Version:                                                                                                 

The fetus turned to a vertex presentation by manipulation through abdominal wall ,it decreased incidence of breech delivery so decreased perinatal mortality and morbidity   ,also decreased incidence of operative delivery                                                                                           

Contraindications of ECV:                                                                                       

Complications of ECV:                                                                                     

Other option is assisted breech delivery:                                                                             

It should be by experienced obstetrician and pediatrician present.                        

First stage of labour:                                                                                            

-partogram : follow the progress of labour                                             

-fetal heart monitoring                                                                              

-adequate hydration.                                                                               

Second stage of labour:                                                                                

Steps of assisted breech delivery                                                     

Third stage of labour:                                                                                

Indications of operative delivery:                                                                         

Current evidence supports elective CS for term breech presentation ,although morbidity and mortality more influenced by the gestation  and estimated birth weight than mode of delivery                                                                                                                                                 .