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]:
- Mukhopadhyay S, Arulkumaran S. Breech delivery. Best Pract Res Clin Obstet Gynaecol 2002; 16:31.
- Vaginal breech delivery and symphysiotomy http://apps.who.int/rhl/videos/en/ (Accessed on September 14, 2012).
- ACOG Committee on Obstetric Practice. ACOG Committee Opinion No. 340. Mode of term singleton breech delivery. Obstet Gynecol 2006; 108:235.
- Su M, McLeod L, Ross S, et al. Factors associated with adverse perinatal outcome in the Term Breech Trial. Am J Obstet Gynecol 2003; 189:740.
- Bingham P, Lilford RJ. Management of the selected term breech presentation: assessment of the risks of selected vaginal delivery versus cesarean section for all cases. Obstet Gynecol 1987; 69:965.
- Kotaska A, Menticoglou S, Gagnon R, et al. Vaginal delivery of breech presentation. J Obstet Gynaecol Can 2009; 31:557.
- Goffinet F, Carayol M, Foidart JM, et al. Is planned vaginal delivery for breech presentation at term still an option? Results of an observational prospective survey in France and Belgium. Am J Obstet Gynecol 2006; 194:1002.
- Hannah ME, Hannah WJ, Hewson SA, et al. Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Term Breech Trial Collaborative Group. Lancet 2000; 356:1375.
- Svenningsen NW, Westgren M, Ingemarsson I. Modern strategy for the term breech delivery--a study with a 4-year follow-up of the infants. J Perinat Med 1985; 13:117.
- Westgren M, Grundsell H, Ingemarsson I, et al. Hyperextension of the fetal head in breech presentation. A study with long-term follow-up. Br J Obstet Gynaecol 1981; 88:101.
- Ballas S, Toaff R. Hyperextension of the fetal head in breech presentation: radiological evaluation and significance. Br J Obstet Gynaecol 1976; 83:201.
- van Loon AJ, Mantingh A, Serlier EK, et al. Randomised controlled trial of magnetic-resonance pelvimetry in breech presentation at term. Lancet 1997; 350:1799.
- Uygur D, Kiş S, Tuncer R, et al. Risk factors and infant outcomes associated with umbilical cord prolapse. Int J Gynaecol Obstet 2002; 78:127.
- Cheng M, Hannah M. Breech delivery at term: a critical review of the literature. Obstet Gynecol 1993; 82:605.
- Royal College of Obstetricians and Gynaecologist (RCOG). The management of breech presentation. London (UK). RCOG. December 2006.
- Kessler J, Moster D, Albrechtsen S. Intrapartum monitoring with cardiotocography and ST-waveform analysis in breech presentation: an observational study. BJOG 2015; 122:528.
- Bleu G, Demetz J, Michel S, et al. Effectiveness and safety of induction of labor for term breech presentations. J Gynecol Obstet Biol Reprod (Paris) 2016.
- Macharey G, Ulander VM, Heinonen S, et al. Induction of labor in breech presentations at term: a retrospective observational study. Arch Gynecol Obstet 2016; 293:549.
- Beazley JM, Banovic I, Feld MS. Maintenance of labour. Br Med J 1975; 2:248.
- Alarab M, Regan C, O'Connell MP, et al. Singleton vaginal breech delivery at term: still a safe option. Obstet Gynecol 2004; 103:407.
- Bin YS, Roberts CL, Ford JB, Nicholl MC. Outcomes of breech birth by mode of delivery: a population linkage study. Aust N Z J Obstet Gynaecol 2016; 56:453.
- Jotkowitz MW, Picton FC. An appraisal of an anatomically and physiologically correct method of breech delivery: the Bracht manoeuvre. Aust N Z J Obstet Gynaecol 1970; 10:151.
- Heres MH, Pel M, Elferink-Stinkens PM, et al. The Dutch obstetric intervention study--variations in practice patterns. Int J Gynaecol Obstet 1995; 50:145.
- Grosfeld O, Kretowicz J, Brokowski J. The temporomandibular joint in children after breech delivery. J Oral Rehabil 1980; 7:65.
- Verkuyl DA. Think globally act locally: the case for symphysiotomy. PLoS Med 2007; 4:e71.
- Menticoglou SM. Symphysiotomy for the trapped aftercoming parts of the breech: a review of the literature and a plea for its use. Aust N Z J Obstet Gynaecol 1990; 30:1.
- Björklund K. Minimally invasive surgery for obstructed labour: a review of symphysiotomy during the twentieth century (including 5000 cases). BJOG 2002; 109:236.
- Sunday-Adeoye IM, Okonta P, Twomey D. Symphysiotomy at the Mater Misericordiae Hospital Afikpo, Ebonyi State of Nigeria (1982-1999): a review of 1013 cases. J Obstet Gynaecol 2004; 24:525.
- Onah HE, Ugona MC. Preferences for cesarean section or symphysiotomy for obstructed labor among Nigerian women. Int J Gynaecol Obstet 2004; 84:79.
- Verkuyl DA. Symphysiotomies are important option in developing world. BMJ 2001; 323:809.
- Iffy L, Apuzzio JJ, Cohen-Addad N, et al. Abdominal rescue after entrapment of the aftercoming head. Am J Obstet Gynecol 1986; 154:623.
- Steyn W, Pieper C. Favorable neonatal outcome after fetal entrapment and partially successful Zavanelli maneuver in a case of breech presentation. Am J Perinatol 1994; 11:348.
- Sandberg EC. The Zavanelli maneuver: 12 years of recorded experience. Obstet Gynecol 1999; 93:312.
- Ross MG, Beall MH. Cervical neck dislocation associated with the Zavanelli maneuver. Obstet Gynecol 2006; 108:737.
- Goldenberg RL, Nelson KG. The unanticipated breech presentation in labor. Clin Obstet Gynecol 1984; 27:95.
- Richmond JR, Morin L, Benjamin A. Extremely preterm vaginal breech delivery en caul. Obstet Gynecol 2002; 99:1025.
- Ezra Y, Wade C, Rolbin SH, Farine D. Uterine tocolysis at cesarean breech delivery with epidural anesthesia. J Reprod Med 2002; 47:555.
- Haesslein HC, Goodlin RC. Delivery of the tiny newborn. Am J Obstet Gynecol 1979; 134:192.
- Westgren LM, Songster G, Paul RH. Preterm breech delivery: another retrospective study. Obstet Gynecol 1985; 66:481.
- Westgren M, Ingemarsson I, Ahlström H, et al. Delivery and long-term outcome of very low birth weight infants. Acta Obstet Gynecol Scand 1982; 61:25.
- Hobel CJ, Oakes GK. Special considerations in the management of preterm labor. Clin Obstet Gynecol 1980; 23:147.
- Schutterman EB, Grimes DA. Comparative safety of the low transverse versus the low vertical uterine incision for cesarean delivery of breech infants. Obstet Gynecol 1983; 61:593.
- de Hundt M, Vlemmix F, Bais JM, et al. Risk factors for developmental dysplasia of the hip: a meta-analysis. Eur J Obstet Gynecol Reprod Biol 2012; 165:8.
- Illingworth RS. A paediatrician asks--why is it called birth injury? Br J Obstet Gynaecol 1985; 92:122.
- 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