Delivery of the fetus in breech presentation
- G Justus Hofmeyr, MD
G Justus Hofmeyr, MD
- University of the Witwatersrand
- University of Fort Hare, South Africa
Vaginal breech deliveries occur, even in institutions with a policy of routine cesarean delivery for breech presentation, because of situations such as precipitous delivery, out of hospital delivery, severe fetal anomaly or fetal death, and mother's preference for vaginal birth. Therefore, it is essential for clinicians to maintain the skills of breech delivery.
This topic will review techniques for vaginal breech birth. Choosing the best route of delivery of the fetus in breech presentation is reviewed separately. (See "Overview of issues related to breech presentation".)
In the absence of clinical experience, teaching aids such as videos and mannequins can be useful . The following simulation video illustrates one clinician's approach to vaginal breech delivery using Piper forceps to extract the aftercoming head (movie 1).
A free video demonstrating vaginal breech delivery is also available online at the World Health Organization’s (WHO) Reproductive Health Library (RHL) .
VAGINAL BREECH DELIVERY
Criteria for an optimal situation — Various criteria have been developed to minimize the risk of vaginal breech delivery. These criteria for patient selection are largely based upon clinical experience, and typically include [3-6]:
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- VAGINAL BREECH DELIVERY
- Criteria for an optimal situation
- Labor management
- Delivery of the term fetus
- - Preparation
- - Trunk and legs
- - Arms
- - Head
- - Use of forceps
- - Head entrapment
- Delivery of the preterm fetus
- - Dührssen incisions
- CESAREAN BREECH DELIVERY
- Mature breech
- Premature breech
- SPECIAL SITUATIONS
- Delivery of the hydrocephalic fetus in breech presentation
- Delivery in the absence of skilled assistance and appropriate facilities
- NEWBORN EVALUATION
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS
- Vaginal delivery
- Cesarean delivery