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dr. Udin Sabarudin

Department of Obstetrics & GynecologyMedicine School of Padjadjaran University

Bandung

MECHANISM OF LABOR

INBREECH PRESENTATION

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Figure 21-2.Breech presentations. A: Right sacrum posterior (RSP) position. B: Left sacrumanterior (LSA) position. (Redrawn and reproduced, with permission, from Bumm E: Grundiss zumStudium der Geburtshilfe. Bergmann, 1922)

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PREDISPOSING FACTORS :

Prematurity

Uterine abnormalities : -Malformation;

-Fibroids

Fetal abnormalities : -CNS Malformations;

-Neck Masses

Multiple gestations Previous breech delivery

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Gestational age and frequency of breech birth

Gestational age in weeks % Breech

21-24 33

25-28 28

29-32 14

33-36 9

37-40 7

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DIAGNOSIS :

Palpation and ballottement

Ultrasound

Pelvic examination

X-Ray studies

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Leopold Maneuver

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MANAGEMENT DURING LABOR

Type of Delivery

Vaginal delivery:

Spontaneous

Partial breech extraction

Total breech extraction

Cesarean of delivery

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Management

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Three types of vaginal breech delivery exist

Spontaneous breech (rare) : No manipulation of theinfant is necessary, other than supporting the infant.

Partial breech extraction : Fetus descend

spontaneously to where umbilicus is at the vaginal

introitus; then, the fetus is extracted completely.

Total breech extraction : The entire body is extracted

This is indicated only if there is evidence of fetal

distress unresponsive to routine maneuvers and acesarean delivery is not possible.

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Conditions are unfavorable for breech delivery

Fetus weight more than 3500 g Unfavorable pelvis Breech delivery does not

allow sufficient time for molding of the fetal head;thus, a platypelloid or android pelvis decreases

ability fetal head to navigate maternal pelvis

Hyperextension of the head increases risk ofcervical spine injury

Footlings- incidence of umbilical cord prolapseincreases with coiling of the umbilical cord aroundthe legs of the fetus

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MORTALITY/MORBIDITY

Increased birth trauma: As duration ofumbilical cord compression increases deliverthe infant more rapidly increasing birth

trauma

Decreased birth weight may result frompreterm delivery/growth restriction

Incidence of prolapsed umbilical cord depends

on type of breech presentation : Footling 17%,Complete 5%, Frank 0,5%

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Mechanism of Labor in Breech Delivery

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Assisted Delivery of Frank Breech

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Assisted Delivery of Frank Breech

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Assisted Delivery of Frank Breech

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Assisted Delivery of Frank Breech

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Assisted Delivery of Frank Breech

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Assisted Delivery of Frank Breech

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Assisted Delivery of Frank Breech

M h i f L b i B h D li

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Mechanism of Labor in Breech Delivery

Figure 21-5.Maneuver for delivery of the head. The fingers of the left handare inserted into the infants mouth of over mandible; the right hand exertspressure on the head from above. (Modified and reproduced, withpermission, from Benson RC:Handbook of Obstetrics & Gynecology, 8thed.Lange, 1983)

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Mauriceau Maneuver

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Delivery of the Aftercoming Head

Piper forceps

Modified prague maneuver

Mechanism of Labor in Breech Delivery

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Mechanism of Labor in Breech Delivery

Figure 21-12.Application of Piper forceps, employing towel sling support. The forceps areintroduced from below, left blade first. Aiming directly and intended positions on sides ofthe head. (Reproduced, with permission, from Benson RC:Handbook of Obstetrics &Gynecology, 8thed. Lange, 1983)

F t Aft i H d

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Forceps to Aftercoming Head

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C l t I l t B h E t ti

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Complete or Incomplete Breech Extraction

C l t I l t B h E t ti

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Complete or Incomplete Breech Extraction

C l t I l t B h E t ti

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Complete or Incomplete Breech Extraction

Complete o Incomplete B eech E t action

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Complete or Incomplete Breech Extraction

Breech Extraction

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Breech Extraction

C Section Indication

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C-Section Indication

A large fetus ( > 3.500 gr )A Hyperextended fetus

Uterine dysfunction

Footling presentation

Any degree of contraction or unfavorableshape restriction

Previous perinatal death or children sufferingfrom birth trauma

COMPLICATIONS

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COMPLICATIONS

1. Perinatal morbidity and mortality from difficult deliver

2. Low birthweight from preterm delivery, growthrestriction, or both

3. Prolapsed cord

4. Placenta previa

5. Fetal, neonatal, and infant anomalies

6. Uterine anomalies and tumors

7. Multiple fetuses

8. Operative intervention, especially cesarean delivery

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