In breech presentation, the lie is longitudinal and the podalic pole presents at the pelvic brim. It is the commonest malpresentation.
“A breech presentation occurs when the baby’s buttocks or both are in place to come out first during birth. Breech presentation is often determined by fetal ultrasound at the end of pregnancy”.
Incidence–
The incidence is about 20% at 28th week and drops to 5% at 34th week and to 3-4%at term. Thus in 3out of 4, spontaneous correction into vertex presentation occurs by 34th week. The incidence is expected to be low in hospitals where high parity births are minimal and routine external cephalic version is done in in antenatal period.
Varieties–
There are two varieties of breech presentation-
Complete,
Incomplete,
Complete (flexed breech)-
The normal attitude of full flexion is maintained. The thighs are flexed at the hips and the legs at the knees. The presenting part consists of two buttocks, external genitalia and two feet. It is commonly present in multiparae (10%).
Incomplete– This is due to varying degrees of extension of thighs or legs at the podalic pole. Three varieties are possible;
Breech with extended legs (Frank breech):-
In this condition, the thighs are flexed on the trunk and the legs are extended at the knee joints. The presenting part consists of the two buttocks and external genitalia only. It is commonly present in Primigravida, about 70%. The increased prevalence in Primigravida is due to a tight abdominal wall, good uterine tone and early engagement of breech.
Footling presentation (25%):-
Both the thighs and the legs are partially extended bringing the legs to present at the brim.
Knee presentation:-
Thighs are extended but the knees are flexed, bringing the knees down to present at the brim. The latter two varieties are not common.
Clinical varieties–
In an attempt to find out the dangers inherent to breach, breech presentation is clinically classified as;
Uncomplicated,
Complicated,
Causes of Breech In Pregnancy
Some of the common reasons include:- too much or too little amniotic fluid around the baby. the length of the umbilical cord. multiple pregnancy. Example, often one twin will be in a head-down position and the other in a breech position.
If the uterus has too much or too little amniotic fluid, meaning the baby has extra room to move around in or not enough fluid to move around in.
If a woman has had several pregnancies.
If a woman has had a premature birth in the past.
The signs of a breech baby-
your due date nears, your doctor or midwife will determine your baby’s position by feeling the outside of your abdomen and uterus. If your baby is breech, her firm, round head will be toward the top of your uterus and her softer, less round bottom will be lower.
Where do you feel movement with breech babies?
Bottom-down (breech) position
If his feet are up by his ears (frank breech), you may feel kicks around your ribs. But if he’s sitting in a cross-legged position (complete breech), his kicks are likely to be lower down, below your belly button. In other words we define-
If your baby is in breech position, you may feel her kicking in your lower belly. Or you may feel pressure under your ribcage, from her head.
Can breech baby break your water?
It is important to go in right away if you have a breech baby and your bag of water breaks. This is because there is a higher chance that the cord will come out even before you are in labor. This can be very dangerous for the baby.
Are breech babies more painful to carry?
Giving birth to a breech baby vaginally is not usually any more painful than a head-down position, as you’ll have the same pain relief options available to you, although it does carry a higher risk of perinatal morbidity.
Are breech babies always delivered by C section?
This is the normal and safest fetal position for birth. But in about 4 out of 100 births, the baby doesn’t naturally turn head-down. Instead, the baby is in a breech position. Babies in breech position usually must be delivered by C-section.
Is a breech baby high risk?
In general, breech pregnancies aren’t dangerous until it’s time for the baby to be born. With breech deliveries, there is a higher risk for the baby to get stuck in the birth canal and for the baby’s oxygen supply through the umbilical cord to get cut off.
Why can’t you deliver a breech baby vaginally?
Complications of vaginal breech delivery:
The fetal head may get trapped due to an incompletely stretched uterine mouth, causing the head to get stuck at the cervix. A cervical cut may be required to relieve cervical entrapment.
Diagnosis of breech presentation–
Diagnosis of a breech presentation can be accomplished through abdominal exam using the Leopold maneuvers in combination with the cervical exam. Ultrasound should confirm the diagnosis. On ultrasound, the fetal lie and presenting part should be visualized and documented.
What is the treatment of breech presentation?
Sometimes a doctor can turn a baby from a breech position to a head-down position by using a procedure called an external cephalic version. (If you are using a midwife and your baby is in breech position, your midwife will refer you to a doctor for this procedure).
Is breech presentation abnormal?
Breech presentation
It is the second most common type of abnormal presentation. When delivered vaginally, babies that present buttocks first are more likely to be injured than those that present head first. Such injuries may occur before, during, or after birth.
What causes breech position?
Most of the time, there is no clear reason why the baby did not turn head-down. In some cases, breech position may be linked to early labor, twins or more, problems with the uterus, or problems with the baby.
Are breech babies boy or girl?
Boys are little more common than girls in head presentation in the higher weight groups, in breech presentation in the upper and lower weight groups, while girls predominate in the middle weight groups. The absolute size of the middle weight groups in breech presentation causes the small excess of girls.
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