MANAGEMENT OF BREECH PRESENTATION (BREECH BABY)

Management of breech presentation(Breech baby)

MANAGEMENT OF BREECH PRESENTATION (BREECH BABY)

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Overview

For an expectant mother, who wants to deliver her baby via the vagina, a baby in a breech presentationcould be a source of anxiety.

When a fetus is in a longitudinal position and lie with the buttocks or feet closest to the cervix, this defines Breech presentation. This occurs in 3-4% of all pregnancies. With advancing gestational age (The percentage of breech deliveries decreases) from 22-25% of births prior to 28 weeks' gestation to 7-15% of births at 32 weeks' gestation to 3-4% of births at term.

Predisposing factors for breech presentation include

Ø Prematurity,

Ø Uterine malformations or fibroids,

Ø Polyhydramnios,

Ø Placenta previa,

Ø fetal abnormalities (eg, CNS malformations, neck masses, aneuploidy), and

Ø multiple pregnancies .

Ø 17% of preterm breech deliveries and in 9% of term breech deliveries is usually characterized with Fetal abnormalities.

Irrespective of the mode of delivery Perinatal mortality is increases 2- to 4-fold in cases of breech presentation

 

"Management of breech presentation(Breech baby)"

 

Types of breech position

  • Frank breech ( most prevalent 50-70%) - involves extended knees, Hips flexed, ( also called pike position)
  • Complete breech (prevalence: 5-10%) - involves Hips flexed, knees flexed ( also called cannonball position)
  • Footling or incomplete (10-30%) - One or both hips extended, foot presenting
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"Management of breech presentation(Breech baby)"

Management of breech presentation

  • Even though there are various methods to the approach for delivering breech pregnancy; the general consensus is a method that ensures the safety of the mother and the baby.
  • Women with such cases should be given the opportunity to make informed decisions about their care and treatment, in partnership with the clinicians providing care.
  • Birth planning demands careful assessment for risk of poor outcomes relating to planned vaginal breech birth. If any risk factors are identified, inform the woman that an caesarean section is recommended due to increased perinatal risk.
  • Good communication between clinicians and women is essential. Treatment, care and information provided should:
  • ensure women's individual needs and preferences should also be taken into account
  • be backed up with evidence-based, information written which tailors to the needs of the individual woman
  • be culturally appropriate
  • be accessible to women, their partners, support people and families
  • take into account any specific needs, such as physical or cognitive disabilities or limitations to their ability to understand spoken or written English.

 

"Management of breech presentation(Breech baby)"

Documentation

The following should be documented in the woman's hospital medical record and (where applicable) in her hand-held medical record:

  • discussion of risks and benefits of vaginal breech birth and elective caesarean section
  • discussion of the woman's questions about planned vaginal breech birth and elective caesarean section
  • discussion of external cephalic version, if applicable
  • consultation, referral and escalation

 

"Management of breech presentation(Breech baby)"

Management Proper

All breech pregnancies must be confirmed using ultrasound scan.

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Breech pregnancy is a high risk pregnancy and should be managed by a specialist.

The two options for managing a breech pregnancy include

  • External cephalic version (ECV). This process occur when labour is expected. Here, the clinician attempts to turn the baby and maintain it in such position until the baby is delivered through the vagina.
  • Caesarean section

Decisions regarding whether a woman will deliver a breech baby depends on the following factors

ü The age of the baby in the womb

(1) If the baby is 34 weeks and less; there is a chance that the baby will revert to the normal cephalic (head down) position. Usually the clinician counsels the expectant mum and teaches her some of the exercises that can help with spontaneous turning of the baby

(2) If the baby is above 34 weeks, the chance of spontaneous reversion is less; in this case ,the options available for delivery should be discussed with the woman.

  • The choice of the mother. The expectant mother should be fully informed of available options. Her choice should be respected.
  • Contraindications (Conditions that prevents vaginal delivery)

 

"Management of breech presentation(Breech baby)"

 

These will include

  1. a) Fetal macrosomia (big baby)
  2. b) Abnormal location of placenta towards the cervix
  3. c) Abnormality of the uterus (womb)
  4. d) Oligohydramnios (little amniotic fluid)
  5. e) Fetal anomaly
  6. f) Cord prolapse
  7. g) Fetal growth restriction
  8. h) Severe hypertension in pregnancy
  9. i) Existing mother`s health challenges

 

Conclusion

Breech pregnancies are usually high risk pregnancies. High index of suspicion on the part of the clinician and all labour attendants should be the norm. Needed exercises should instituted on time. All health personels that attend to labour cases should be trained and retrained on breech pregnancy and it`s management. Appropriate referrals should be made to higher levels of care on time.

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"Management of breech presentation(Breech baby)"

 

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