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Breech Delivery

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Breech Delivery

  • See Also
  1. Breech Presentation
  2. Malpresentation
  3. External Cephalic Version
  • Epidemiology
  1. Breech Vaginal Delivery is uncommon in United States (typically emergent, unexpected)
  2. In U.S., 90% of Breeches are delivered by ceserean
  • Indications
  1. Complete or Full Breech Presentation
  2. Estimated fetal weight between 2 to 4 kg
  3. Expert physician
  • Contraindications
  1. Unfavorable Pelvis (e.g. android, platypelloid, small)
  2. Fetal Macrosomia (3800 grams)
  3. Suspected utero-placental insufficiency
  4. Intrauterine Growth Retardation
  5. Footling Breech
  6. Fetal Hydrocephalus
  7. Inexperienced clinician
  8. Hyperextension of fetal head
  9. Severe prematurity
  • Management
  1. Overall approach for non-Obstetricians (e.g. emergency department)
    1. Call for obstetrics backup
    2. Obtain Intravenous Access
    3. Tocometry and Intrapartum Fetal Monitoring
    4. Hands off approach is generally recommended regardless of presenting part
      1. Do not apply traction or pulling
      2. Do not replace presenting part (cord prolapse risk)
    5. Allow Cervix to dilate, reducing the risk of head entrapment
      1. If Cervix fully dilated, mother may push with contractions
    6. Findings of severe Fetal Distress
      1. Cyanosis of the presenting part
    7. Findings of arrested labor
      1. Contractions are not associated with presenting part descent
      2. Contractions infrequent or weak
      3. Arm presentations (Transverse Lie)
    8. References
      1. Kobner, Borhart and Vieth (2024) Difficult Deliveries, EM: Rap, 10/21/2024, accessed 10/31/2024
  2. Adjunctive measures
    1. Large episiotomy
    2. Piper forceps
    3. Empty Bladder with catheterization
  3. Footling Breech
    1. Deliver the first leg and then the second
    2. Grasping both legs, deliver body to level of Umbilicus
    3. With the baby's buttock's up, deliver baby to the level of their chest
    4. Rotate the baby 90 degrees and swep out one arm
    5. Rotate the baby 180 degrees and sweep out the other arm
    6. Deliver the Shoulders
    7. With your finger in the baby's mouth, pull down to deliver the head
      1. Avoids Stretching neck
      2. Consider applying suprapubic pressure
  • Complications of Breech Delivery
  • Maternal
  1. Placental Abruption
  2. Fourth degree perineal tear
  • Complications of Breech Delivery
  • Fetus
  1. Intracranial Hemorrhage due to rapid molding
    1. Ruptured tentorium cerebelli
    2. Ruptured falx cerebri
  2. Neck Trauma due to traction
    1. Dislocation of neck
    2. Erb-Duchenne Paralysis
    3. Torticollis from Sternocleidomastoid muscle Trauma
  3. Ruptured viscus (Kidney or liver)
    1. Secondary to abdominal pressure from grasp
  4. Genital edema due to caput formation
  5. Shoulder and arm Trauma on delivery of arms
    1. Shoulder Dislocation
    2. Clavicle Fracture
    3. Humerus Fracture
  6. Cord prolapse (more common in Footling Breech)
  7. Hip and leg Trauma from traction
    1. Hip Dislocation
    2. Femur Fracture
    3. Knee Joint disruption