Breech Delivery Clinical Presentation

Updated: Jan 08, 2021
  • Author: Philippe H Girerd, MD; Chief Editor: Ronald M Ramus, MD  more...
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Presentation

History

Factors that increase likelihood of breech delivery include the following:

  • Preterm delivery [10]

  • Increased parity

  • Previous breech delivery

  • Pelvic tumors

  • Uterine anomalies (eg, septate uterus)

  • Older maternal age [8]

  • Polyhydramnios

  • Fetal anomalies (eg, hydrocephalus with macrocrania)

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Physical Examination

Physical findings may include the following:

  • 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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