BREECH PRESENTATION Lecturer: Dr. Hui Wang Department of Obstetrics & Gynaecology Tongji Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan, China

INDEX DEFINITIONETIOLOGYTYPES CLINICAL SYMPTOMS AND SIGNS DIAGNOSIS MORBIDITY AND MORTALITY TREATMENT TERMINATION OF CONCEPTION

DEFINITION Breech presentation is defined as the fetal breech go into the pelvic cavity instead of fetal head or shoulder. Breech presentation is defined as the fetal breech go into the pelvic cavity instead of fetal head or shoulder.

Brief introduction A common malpresentation Denominator: sacrum (S) LSA, RSA LSA, RSA LSP, RSP LSP, RSP LST, RST LST, RST Incidence: 2 ~ 5 % in singleton deliveries

AETIOLOGY Twin or multiple pregnancy Polyhydramnios Fetal malformation: anencephaly hydrocephaly Uterine anomalies Placenta previa

CLASSFICATION 1. Frank breech Lower legs extended and thighs flexes Lower legs extended and thighs flexes 2. Complete (full breech) Fully flexes both of thighs and lower legs Fully flexes both of thighs and lower legs 3. Incomplete (footling / knee breech) one or both thighs extended one or both thighs extended

Three types of breech presentation

COMPLICATIONS Premature rupture of membrane (PROM) Prolapse of umbilical cord Preterm delivery Fetal birth injury Intrauterine infection

Infant and maternal Morbidity & Mortality Neonatal asphyxia due to premature of lung Acute fetal death due to prolapse of the cord Fetal injuries by mechanic trauma such as fracture of femur bone by artificial stretch Intrauterine infection Puerperium infection

TREATMENT Prenatal examination Avoid intercourse and other mechanic stimulation. Hospitalization at least 3 weeks in advance Selected cesarean section after 37 gestational weeks with the infant weight more 2500 g by estimation (2000 g in some authors). Avoid acute movement and special position (chest-knee- down position)

Termination of pregnancy Principle: baby safe Best choice: cesarean section Vaginal delivery

Indications for vaginal delivery Normal heart rate (non of fetal distress) Normal amniotic fluid volume and placenta function Fetal estimated weight < 2500 g in Frank type Without other obstetrical complications such as abnormal pelvis, pre-eclampsia, placenta previa, uterine cicatrix or other internal medicine diseases