Breech delivery

Revision as of 08:06, 3 August 2015 by Mholtz (talk | contribs) (Updated background, features, and management)

Background

  • 3-4% of term deliveries.[1] (Most common fetal malpresentation[2])
  • In normal delivery, head dilates cervix and allows body to pass relatively easily.
    • In breech delivery, body first does not first maximally dilate cervix → higher risk of head entrapment, cord prolapse, and death.

Clinical Features

Three Types of Breech Delivery[1]

  • Frank - Buttocks deliver first, hips flexed, knees extended (most common type)
  • Complete - Buttocks deliver first, hips and knees flexed
  • Incomplete - (aka "footling") One or both feet deliver first

Differential Diagnosis

Emergent delivery and related complications

Diagnosis

  • In ED precipitous delivery, this is a clinical diagnosis.
  • If time allows, ultrasound can reveal position of fetus, but often not possible in ED deliveries.

Management

  • Immediate OB/Gyn consult
    • If OB/Gyn immediately available and delivery has not progressed, Zavanelli maneuver has been described for breech births and may be considered.
      • Zavanelli maneuver - pushing presenting fetal part back into vagina until C-Section can be performed[3]

Disposition

  • Admit to L&D.

See Also

External Links

References

  1. ↑ 1.0 1.1 Silver DW, Sabatino F. Precipitous and difficult deliveries. Emerg Med Clin North Am. 2012 Nov;30(4):961-75. doi: 10.1016/j.emc.2012.08.004.
  2. ↑ Mercado J. Critical obstetric and gynecologic procedures in the emergency department. Emerg Med Clin North Am. 2013 Feb;31(1):207-36.
  3. ↑ Timothy F Kirn. To Handle Breech Births, Know Two Maneuvers. ACEP News May 2008. ACEP News Accessed 08/03/15.
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