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