Deepa Mishra M Sc Nursing OBG INTRODUCTION A breech birth is the birth of a baby from a breech presentation in which the baby exits the pelvis with the buttocks or feet first as opposed to the normal headfirst presentation In breech presentation fetal heart sounds are heard just above t ID: 229361
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Slide1
BREECH DELIVERY
Deepa Mishra
M. Sc. Nursing (OBG)Slide2
INTRODUCTION
A breech birth is the birth of a baby from a breech presentation, in which the baby exits the pelvis with the buttocks or feet first as opposed to the normal head-first presentation. In breech presentation, fetal heart sounds are heard just above the umbilicus. In a breech presentation, the lie is longitudinal and the podalic pole presents at the pelvic brim. It is the commonest malpresentation.Slide3
DEFINITION
It is a longitudinal lie in which the buttocks is the presenting part with or without the lower limbs.According to Nima
Bhaskar
A breech birth is the birth of a baby from a breech presentation, in which the baby exits the pelvis with the buttocks or feet first as opposed to the normal head-first presentation.
According
to WikipediaSlide4
INCIDENCE
3-4% of fetus present by breech at term5% at 34 weeks
20%
at 28
weeks
20% diagnosed initially in
labour
3.5%
term singleton deliveries and about 25% of cases before 30 weeks of gestation undergo spontaneous cephalic version up to term.
Slide5
TYPESSlide6
Complete
Breech (Flexed Breech)Slide7
2.
Incomplete Breech(30-35%)Slide8
INCOMPLETE BREECHSlide9
TYPES OF INCOMPLETE BREECHSlide10
CLINICAL VARIETIESSlide11
POSITIONSSlide12
Etiology Of Breech PresentationSlide13
DIAGNOSISSlide14
CLINICAL
Complete Breech
Frank Breech
Per Abdomen
Fundal Grip
Head-
suggested by hard and globular mass
Head is ballottable
Head
Irregular small parts of the feet may be felt by the side of the head.
Head is non-
ballottable
due to splinting action of the legs on the trunk.
Lateral Grip
Fetal back is to one side and the irregular limbs to the other
Irregular parts are less felt on the sideSlide15
CLINICAL
Complete Breech
Frank Breech
Pelvic
Grip
F.H.S.
Breech- suggested by soft, broad and irregular mass.
Breech is usually not engaged during pregnancy
Usually located at a higher level round about the umbilicus
Small, hard and a conical mass is felt
The breech is usually
engaged
Located
at a lower level in the midline due to early engagement of the breech
Per
Vaginum
During Pregnancy
During labour
Soft
and irregular parts are felt through the fornix
Palpation of
ischial
tuberosities
, sacrum and the feet by the sides of the
buttocks
The foot felt is identified by the prominence of the heel and lesser mobility of the great toe.
Hard
feel of the sacrum is felt, often mistaken for the head
Palpation of
ischial
tuberosities
, anal opening and sacrum onlySlide16
Ultrasonography
1. It confirms the clinical diagnosis- specially in primigravidae with engaged frank breech or with tense abdominal wall and irritable uterus.2
. It
can detect fetal congenital abnormality and also congenital anomalies of the uterus.
3.
Type
of breech (complete or incomplete).
4.
It
measures
biparietal
diameter, gestational age and approximate weight of the fetus.
5
. It
also localizes the placenta.
6
. Assessment
of liquor volume (important for ECV).
7.
Attitude
of the head- flexion or hyperextension (Important for decision making at the time of delivery).
8. CT
and MRI can be used to assess the pelvic capacity in addition to all the above mentioned information.Slide17
DURING PREGNANCYSlide18
DURING LABOUR
The 3 bony landmarks of breech namely 2
ischial
tuberosities
and tip of the
scarum
.
The feet are felt beside the buttocks in complete breech.
Fresh meconium may be found on the examining fingers.
Male genitalia may be felt.
Slide19
MECHANISM OF LABOURSlide20
Delivery of ButtocksSlide21
Delivery of ShouldersSlide22
Delivery of HeadSlide23
PROGNOSISSlide24Slide25Slide26
External Cephalic VersionSlide27
ELECTIVE CAESARIAN SECTIONSlide28
VAGINAL BREECH DELIVERYSlide29
ASSISTED BREECH DELIVERYSlide30
ASSISTED BREECH DELIVERYSlide31Slide32
Delayed in Descent of the BreechSlide33
Extended
ArmsSlide34
Arrest
of After Coming HeadSlide35
CONCLUSION
: The incidence of Breech presentation expected to be low in hospitals where high parity births are minimal and routine external cephalic version done in antenatal period. Breech presentation can be managed by early diagnosis and effective management strategies. By using different maneuvers and skillful observation of the obstetrician.Slide36Slide37Slide38