Assisted Vaginal Breech Delivery


Management of Breech presentation:

  1. Offer external cephalic version (ECV)
  2. Plan for elective caesarean section
  3. Vaginal breech delivery (only if refused ECV and LSCS after intense counseling or
    presented with OS full)
    What to do:
  4. Call for help
  5. Os must be full
  6. Inform pediatric team & OT staff
  7. Informed consent taken
    Vaginal Breech Delivery Procedure:
  8. The patient is placed in the lithotomy position.
  9. The bladder is catheterized.
  10. Obstetrician with adequate experience should undertake or supervise the delivery.
  11. Pediatrician to standby for neonatal resuscitation.
  12. The basic principle in delivering breech is to employ the “hands off technique”.
  13. Allow breech to descend with contractions and maternal effort. Do not pull the baby out.
  14. An episiotomy may be performed if needed when the anus is visible over the fourchette.
  15. Extended legs are delivered by flexion at the knee joint and extension at the hips.
  16. Loosen the cord if the cord is tight.
  17. Once the body is out, wrap the baby in a warm clean towel.
  18. Hold the baby at the pelvic bony regions and legs.
  19. Once the scapula tip of the anterior shoulder is visible, run a finger over the shoulder
    and down to the elbow to deliver the arm.
  20. Employ the Lovset maneuver if delivery complicated by extension or nuchal
    displacement of the arm.
  21. After arms are delivered, let the baby lie supported as the head engages.
  22. Once the hair line is seen, deliver the head using the Mauriceau-Smellie-Veit (SMV)
    method or Burns-Marshall method.
  23. Once head is delivered, employ the active management of the 3rd stage.
  24. After delivery of the placenta, perineum check is done to rule out any genital tract injury.