Breech Birth

Published on 31/05/2015 by admin

Filed under Obstetrics & Gynecology

Last modified 22/04/2025

Print this page

rate 1 star rate 2 star rate 3 star rate 4 star rate 5 star
Your rating: none, Average: 0 (0 votes)

This article have been viewed 2237 times

Chapter 199 Breech Birth

INTRODUCTION

Description: Breech birth is presentation of the fetal buttocks, one foot, or both feet at the cervix at the time of labor.
Prevalence: Three percent of term pregnancies, 13% of pregnancies at 30 weeks of gestation.
Predominant Age: Reproductive (maternal).
Genetics: No genetic pattern.

ETIOLOGY AND PATHOGENESIS

Causes: Prematurity, fetal or maternal anomalies (e.g., fetal hydrocephalus, maternal uterine anomalies), multiple gestation.
Risk Factors: Prematurity, fetal or uterine anomalies, multiple pregnancies.

CLINICAL CHARACTERISTICS

Signs and Symptoms

• Fetal head located outside the pelvis on abdominal palpation (Leopold’s maneuvers)
• Fetal heart heard high in the uterus
• Buttock, one foot, or both feet palpable on cervical examination

DIAGNOSTIC APPROACH

Differential Diagnosis

• Fetal anomaly (hydrocephalus, anencephaly)
• Uterine anomaly (septum, duplication, leiomyomata)
• Multiple gestation
• Fetal macrosomia

Associated Conditions: Prematurity, placenta previa, placental abruption, premature rupture of the membranes, congenital anomalies (6% versus 2.5% in total population), intracranial hemorrhage, growth restriction, neurologic disorders and mortality, multiple pregnancy, and polyhydramnios.

Workup and Evaluation

Laboratory: No evaluation indicated beyond that usually considered for patients in labor.
Imaging: Ultrasonography may be used to confirm presentation.
Special Tests: Fetal heart rate and uterine activity monitoring.
Diagnostic Procedures: Physical examination (Leopold’s maneuvers), ultrasonography.

Pathologic Findings

None.

MANAGEMENT AND THERAPY

Nonpharmacologic

General Measures: Fetal and maternal monitoring and support.
Specific Measures: External version, evaluation for route of delivery. External version is successful in >50% of patients. In 2002 the rate of cesarean deliveries for women in labor with breech presentation was 86.9%.
Diet: No specific dietary changes indicated; nothing by mouth if the patient is in labor because of the increased risk of operative delivery.
Activity: No restriction.
Patient Education: Reassurance; American College of Obstetricians and Gynecologists Patient Education Pamphlet AP079 (If Your Baby Is Breech).

Drug(s) of Choice

None (tocolytics may be used to assist with external version procedures).

FOLLOW-UP

Patient Monitoring: Fetal and maternal monitoring as with normal labor.
Prevention/Avoidance: None.

image

Possible Complications: Prolapse of umbilical cord, entrapment of the fetal head, birth trauma.
Expected Outcome: Breech deliveries are associated with an increased risk of congenital anomalies, intracranial hemorrhage, growth restriction, neurologic disorders, and mortality, but the role of breech presentation and the delivery route are unclear. Much of the morbidity traditionally associated with breech presentation and delivery is due to factors that predispose to breech (congenital anomalies, prematurity).

MISCELLANEOUS

Pregnancy Considerations: The route of delivery must be determined on an individual basis based on fetal and maternal factors, the availability of needed resources, and the skill of the obstetrician. Vaginal delivery may be considered if labor is normal, fetal weight is 2000 to 3800 g, fetal status is normal, the pelvis is adequate, fetal head position is normal, and normal progression of cervical dilation and fetal descent are maintained.
ICD-9-CM Codes: 652.2, 652.1 (With successful version).

REFERENCES

Level I

Hannah ME, Hannah WJ, Hewson SA, et al. Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Term Breech Trial Collaborative Group. Lancet. 2000;356:1375.

Hannah ME, Whyte H, Hannah WJ, et al. Maternal outcomes at 2 years after planned cesarean section versus planned vaginal birth for breech presentation at term: the international randomized Term Breech Trial. Term Breech Trial Collaborative Group. Am J Obstet Gynecol. 2004;191:917.

Impey L, Pandit M. Tocolysis for repeat external cephalic version in breech presentation at term: a randomised, double-blinded, placebo-controlled trial. BJOG. 2005;112:627.

Nassar N, Roberts CL, Raynes-Greenow CH, et al. Decision Aid for Breech Presentation Trial Collaborators. Evaluation of a decision aid for women with breech presentation at term: a randomised controlled trial. BJOG. 2007;114:325.

Whyte H, Hannah ME, Saigal S, et al. Outcomes of children at 2 years after planned cesarean birth versus planned vaginal birth for breech presentation at term: the International Randomized Term Breech Trial. Term Breech Trial Collaborative Group. Am J Obstet Gynecol. 2004;191:864.

Level II

Blickstein I, Goldman RD, Kupferminc M. Delivery of breech first twins: a multicenter retrospective study. Obstet Gynecol. 2000;95:37.

Collins S, Ellaway P, Harrington D, et al. The complications of external cephalic version: results from 805 consecutive attempts. BJOG. 2007;114:636. Epub 2007 Mar 12

Goffinet F, Carayol M, Foidart JM, et alPREMODA Study Group. Is planned vaginal delivery for breech presentation at term still an option? Results of an observational prospective survey in France and Belgium. Am J Obstet Gynecol. 2006;194:1002.

Giuliani A, Schöll WM, Basver A, Tamussino KF. Mode of delivery and outcome of 699 term singleton breech deliveries at a single center. Am J Obstet Gynecol. 2002;187:1694.

Martin JA, Hamilton BE, Sutton PD, et al. Births: final data for 2002. Natl Vital Stat Rep. 2003;52:1.

Palencia R, Gafni A, Hannah ME, et alTerm Breech Trial Collaborative Group. The costs of planned cesarean versus planned vaginal birth in the Term Breech Trial. CMAJ. 2006;174:1109.

Rietberg CC, Elferink-Stinkens PM, Visser GH. The effect of the Term Breech Trial on medical intervention behaviour and neonatal outcome in The Netherlands: an analysis of 35,453 term breech infants. BJOG. 2005;112:205.

Su M, Hannah WJ, Willan A, et al. Planned caesarean section decreases the risk of adverse perinatal outcome due to both labour and delivery complications in the Term Breech Trial. Term Breech Trial Collaborative Group. BJOG. 2004;111:1065.

Level III

Alarab M, Regan C, O’Connell MP, et al. Singleton vaginal breech delivery at term: still a safe option. Obstet Gynecol. 2004;103:407.

American College of Obstetricians and Gynecologists. External cephalic version. ACOG Practice Bulletin 13. Washington, DC: ACOG, 2000.

American College of Obstetricians and Gynecologists. Mode of term singleton breech delivery. ACOG Committee Opinion 340. Obstet Gynecol. 2006;108:235.

Burke G. The end of vaginal breech delivery. BJOG. 2006;113:969. Epub 2006 Jul 7

Kotaska A. Inappropriate use of randomised trials to evaluate complex phenomena: case study of vaginal breech delivery. BMJ. 2004;329:1039.

Related posts:

Cervical Incompetence Forceps-Aided Delivery Anorectal Fistula Vaginitis: Bacterial (Nonspecific) and Bacterial Vaginosis Pre-Eclampsia and Eclampsia (Toxemia of Pregnancy) Breast: Galactocele