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Commonest malpresentation.
The incidence is highly dependent on the gestational age.
At 28 weeks about 20 % preganacies, at 34 weeks, 5 %.
By full term, the incidence is about 3%.
Etiology
Factors that appear to predispose to breech presentation -
Prematurity – commonest cause
Polyhydramnios / oligohydramnios
Lax abdominal wall associated with great parity
Multiple fetuses
Hydrocephalus , Anencephaly
Pelvic tumor
Placenta implantation at cornual-fundal region
Uterine abnormalities - Malformation, fibroids
Fetal abnormalities - CNS Malformations; Neck Masses ,
IUD
Previous breech delivery
Types Of Breech
• Complete (10%) : The hips
and knees are flexed
• Incomplete (25%) : due to
varying degrres of
extension of thighs or
legs.
- Frank (65%) : Hips are
flexed, knees are
extended.
- Footling : one of the
lower extremities is
lowermost.
- Knee : one /both knee
are lowermost
Clinical Varieties
Complicated breech
Complicated breech delivery
Positions
Sacrum – denominator.
Anterior positions - sacrum towards iliopubic eminence.
L.S.A.
R.S.A.
Posterior positions - sacrum towards sacro-iliac joint.
R.S.P.
L.S.P.
Diagnosis
Abdominal examination –
Perineal Curve
Piper Forceps
Advantages:
1- Promotion of flexion
2- Traction is directly applied on head preventing
overstretch of neck so protecting roots of brachial plexus
3- Prevention of sudden compression and
decompression of head thus preventing ICH
4- Protection of head from injury by projecting ischial
spines in cases of mild degrees of contracted pelvis
Difficulties
Extended arm (nuchal arm)