II. Epidemiology

  1. Breech Vaginal Delivery is uncommon in United States (typically emergent, unexpected)
  2. In U.S., 90% of Breeches are delivered by ceserean

III. Indications

  1. Complete or Full Breech Presentation
  2. Estimated fetal weight between 2 to 4 kg
  3. Expert physician

IV. 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

V. Technique

  1. Adjunctive measures
    1. Large episiotomy
    2. Piper forceps
    3. Empty Bladder with catheterization
  2. Footling Breech
    1. Deliver the first leg and then the second
    2. Grasping both legs, deliver body to level of Umbilicus
    3. With the baby's buttock's up, deliver baby to the level of their chest
    4. Rotate the baby 90 degrees and swep out one arm
    5. Rotate the baby 180 degrees and sweep out the other arm
    6. Deliver the Shoulders
    7. With your finger in the baby's mouth, pull down to deliver the head
      1. Avoids Stretching neck
      2. Consider applying suprapubic pressure

VI. Complications of Breech Delivery: Maternal

  1. Placental Abruption
  2. Fourth degree perineal tear

VII. 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. Humerus Fracture
  6. Cord prolapse (more common in Footling Breech)
  7. Hip and leg Trauma from traction
    1. Hip Dislocation
    2. Femur Fracture
    3. Knee Joint disruption

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Ontology: Total breech extraction (C0195707)

Concepts Therapeutic or Preventive Procedure (T061)
SnomedCT 177151002, 6707007, 416055001
English breech deliveries, breech delivery, Total breech extraction (treatment), ob serv vaginal delivery breech extraction total, Total breech extraction, Total breech extraction (procedure)
Spanish extracción de nalgas total (procedimiento), extracción de nalgas total