Breech Delivery Follow-up

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

Further Inpatient Care

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  • Warm and dry the infant. Place him or her in an infant incubator.

  • If the infant is younger than 37 weeks' gestation, the lungs may be premature. Consider endotracheal intubation with mechanical ventilation.

  • Even in infants older than 37 weeks' gestation, the infant still should be placed in a hospital with a nursery.

  • Inspect the maternal birth canal, and repair lacerations of the cervix and vagina, as required.

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Inpatient & Outpatient Medications

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  • Administer 300 mcg RhoGAM IM if the mother is Rh negative.

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Transfer

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  • When stable, transfer the infant to the nearest hospital with pediatric intensive care. Otherwise, transfer the infant and mother to a hospital with newborn facilities.

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Complications

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  • Traumatic mortality to the fetus is 12 times more likely.

  • Intracranial fetal hemorrhage is the most common injury in breech delivery.

  • In decreasing order of frequency, the spinal cord, liver, adrenals, and spleen also are injured.

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Prognosis

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  • Fetal and maternal morbidity and mortality increase with breech delivery.

  • Maternal: A rise in the number of cesarean deliveries increases the maternal morbidity and mortality (eg, wound infection, aspiration, anesthesia risk), especially with emergency delivery.

    • Fetus and infant mortality increases to 9%, compared with 3% in cephalic presentations.

    • Average Apgar score, especially at 1 minute, is lower.

    • Congenital abnormalities increase to 6%, compared with 2.4% in infants with cephalic presentations.

    • Factors for increased adverse fetal outcome include the following: [1]

      • Older mothers

      • Footling presentation

      • Hyperextended fetal head

      • Birth weight less than 2500 g or greater than 4000 g

      • Prolonged labor

      • Nonexperienced clinician

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Patient Education

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  • Early prenatal care can identify patients at risk for breech delivery.

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