Breech Delivery Clinical Presentation

Updated: Dec 28, 2015
  • Author: Philippe H Girerd, MD; Chief Editor: Ronald M Ramus, MD  more...
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Presentation

History

See the list below:

  • Factors that increase likelihood of breech delivery include the following:

    • Preterm delivery [4]

    • Increased parity

    • Multiple gestations

    • Previous breech delivery

    • Pelvic tumors

    • Older maternal age [3]

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Physical

See the list below:

  • Leopold maneuvers: With the first maneuver, the hard fetal head can be palpated at the uterine fundus.

  • Auscultation: Heart sounds can be heard above the umbilicus.

  • Vaginal examination

    • In frank breech presentations, the ischial tuberosities, sacrum, anus, and/or genitals may be palpated. In addition, meconium staining of the examiner's digit may occur.

    • In complete breech presentations, the feet or buttocks of the fetus can be palpated.

    • In incomplete breech presentations, one or both of the feet/knees may be palpated.

  • During frank breech delivery, the following conditions make vaginal delivery less risky:

    • Favorable pelvis - Gynecoid (ie, round) or anthropoid (ie, elliptical)

    • Fetal weight less than 3600 g - The larger the fetus, the larger the head, as well as other noncompressible body parts, thereby leading to an increased risk of fetal hypoxia and birth trauma

    • Complete dilation and effacement of the cervix - Provides the head a better chance to pass through the pelvis

    • Availability of skilled obstetrician, neonatal resuscitation equipment, and anesthesia

  • The following conditions are unfavorable for delivery:

    • Fetal weight more than 3600 g

    • Unfavorable pelvis - Breech delivery does not allow sufficient time for molding of the fetal head; thus, a platypelloid (ie, anteroposterior flat) or android (ie, heart-shaped) pelvis decreases the fetal head's ability to navigate the maternal pelvis.

    • Hyperextension of the head - Increases risk of cervical spine injury

    • Footlings - Incidence of umbilical cord prolapse increases with coiling of the umbilical cord around the legs of the fetus

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Causes

See the list below:

  • Risk factors for breech presentation at delivery include the following:

    • Preterm gestational age: Prior to the onset of labor, the fetus typically turns into a cephalic presentation. If labor occurs abruptly or unexpectedly (eg, following trauma), the fetus may not have yet shifted position.

    • Increased maternal parity may cause stretching or laxity of the uterus, predisposing the fetus to breech deliveries.

    • Multiple fetuses: As a result of limited space in the uterus, fetuses may position themselves head to foot.

    • Hydramnios, ie, too much amniotic fluid, may allow the fetus too much movement.

    • Oligohydramnios, ie, too little amniotic fluid, may impede the final shift of the fetus into a cephalic presentation. [5]

    • Placenta previa, ie, placental implantation over the cervical os, allows the fetus too much space for movement within the uterus.

    • Hydrocephalus, ie, enlarged head in the fetus, makes it more difficult for the fetus to make shift to cephalic presentation prior to the onset of labor.

    • Previous breech deliveries may increase likelihood of another one secondary to an anatomical anomaly.

      • Uterine anomalies include uterine scarring from a previous cesarean section, bicornuate uterus, or a septate uterus.

      • Pelvic tumors may impede fetal movement and trap the fetus in a breech presentation.

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