35. Breech presentations. Mechanisms of labor. Manual assistance
Covers breech presentation: how often it occurs, the frank, complete and footling types with a table of leg positions and frequencies, causes, and how it is diagnosed. It then reviews management at term, including external cephalic version and the criteria for vaginal breech birth. The note ends with the mechanism of breech labour and the manual assistance manoeuvres for the body, arms and after-coming head, including Tsovyanov's method.
Topic 35 of 61 in the MU Sofia syllabus for Obstetrics and Gynaecology (Dental Medicine, Year 4). The free AceMed note covers it in 5 sections, about 358 words (3 min of reading), with 16 flashcards.
In this note
Introduction
Types
Management at term
Mechanism of breech labour
Manual assistance
Introduction
In breech presentation the fetal buttocks or feet present. It occurs in about 20% at 28 weeks but only 3–4% at term, because most fetuses turn.
Types
Causes
Preterm birth (most common), uterine anomalies and fibroids, placenta praevia, poly- or oligohydramnios, multiple pregnancy, fetal anomalies (hydrocephalus, anencephaly, neuromuscular disease), short cord. Often no cause is found.
Diagnosis
Hard round head in the fundus, fetal heart above the umbilicus; on vaginal examination the soft buttocks, anus and sacrum (or feet). Confirm by ultrasound.
Management at term
External cephalic version (ECV) from 36–37 weeks: about 50% success; under tocolysis and CTG monitoring; anti-D if RhD-negative. Contraindications: placenta praevia, recent bleeding, ruptured membranes, abnormal CTG, multiple pregnancy (except the second twin), when caesarean is needed anyway.
If the breech persists: planned caesarean section is generally preferred (Term Breech Trial), but vaginal breech birth is an option for selected women with an experienced attendant: frank or complete breech, estimated weight 2.5–3.8 kg, flexed head, adequate pelvis, no other complications.
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