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Breech Delivery
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Breech Delivery
See Also
Breech Presentation
Malpresentation
External Cephalic Version
Epidemiology
Breech
Vaginal Delivery
is uncommon in United States (typically emergent, unexpected)
In U.S., 90% of
Breech
es are delivered by ceserean
Indications
Complete or Full
Breech Presentation
Estimated fetal weight between 2 to 4 kg
Expert physician
Contraindications
Unfavorable
Pelvis
(e.g. android, platypelloid, small)
Fetal Macrosomia
(3800 grams)
Suspected utero-placental insufficiency
Intrauterine Growth Retardation
Footling Breech
Fetal
Hydrocephalus
Inexperienced clinician
Hyperextension of fetal head
Severe prematurity
Technique
Adjunctive measures
Large episiotomy
Piper forceps
Empty
Bladder
with catheterization
Footling Breech
Deliver the first leg and then the second
Grasping both legs, deliver body to level of
Umbilicus
With the baby's buttock's up, deliver baby to the level of their chest
Rotate the baby 90 degrees and swep out one arm
Rotate the baby 180 degrees and sweep out the other arm
Deliver the
Shoulder
s
With your finger in the baby's mouth, pull down to deliver the head
Avoids
Stretching
neck
Consider applying suprapubic pressure
Complications of Breech Delivery
Maternal
Placental Abruption
Fourth degree perineal tear
Complications of Breech Delivery
Fetus
Intracranial Hemorrhage
due to rapid molding
Ruptured tentorium cerebelli
Ruptured falx cerebri
Neck
Trauma
due to traction
Dislocation of neck
Erb-Duchenne Paralysis
Torticollis
from Sternocleidomastoid muscle
Trauma
Ruptured viscus (
Kidney
or liver)
Secondary to abdominal pressure from grasp
Genital edema due to caput formation
Shoulder
and arm
Trauma
on delivery of arms
Shoulder Dislocation
Clavicle Fracture
Humerus Fracture
Cord prolapse (more common in
Footling Breech
)
Hip and leg
Trauma
from traction
Hip Dislocation
Femur Fracture
Knee Joint
disruption
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