Breech Delivery

Aka: Breech Delivery

1. Epidemiology
   1. BreechVaginal Delivery is uncommon in United States
   2. In U.S., 90% of Breeches are delivered by ceserean
2. Indications
   1. Complete or Full Breech Presentation
   2. Estimated fetal weight between 2 to 4 kg
   3. Expert physician
3. Contraindications
   1. Unfavorable Pelvis (e.g. android, platypelloid, small)
   2. Fetal Macrosomia (3800 grams)
   3. Suspected utero-placental insufficiency
   4. Intrauterine Growth Retardation
   5. Footling Breech
   6. Fetal Hydrocephalus
   7. Inexperienced clinician
   8. Hyperextension of fetal head
   9. Severe prematurity
4. Technique
   1. Large episiotomy
   2. Piper forceps
5. Complications of Breech Delivery: Maternal
   1. Placental Abruption
   2. Fourth degree perineal tear
6. Complications of Breech Delivery: Fetus
   1. Intracranial Hemorrhage due to rapid molding
      1. Ruptured tentorium cerebelli
      2. Ruptured falx cerebri
   2. Neck Trauma due to traction
      1. Dislocation of neck
      2. Erb-Duchenne Paralysis
      3. Torticollis from Sternocleidomastoid muscle trauma
   3. Ruptured viscus (Kidney or liver)
      1. Secondary to abdominal pressure from grasp
   4. Genital edema due to caput formation
   5. Shoulder and arm trauma on delivery of arms
      1. Shoulder Dislocation
      2. Clavicle Fracture
      3. HumerusFracture
   6. Cord prolapse (more common in Footling Breech)
   7. Hip and leg trauma from traction
      1. Hip Dislocation
      2. FemurFracture
      3. Knee Joint disruption