Diagnosing Breech Presentation

Diagnosing a breech presentation can be very tricky, but once you are aware of the signs to look for you can detect it, although it might not be easy.

Breech presentation is known as the mal positioning of an unborn baby in the womb of the mother.

In detecting and diagnosing a breech presentation, there are few parameters one should look for especially if you are a medical practitioner.

Parameters for Diagnosing Breech Presentation

Just like I said earlier, there are parameters a medical practitioner needs to look for in order to diagnose a breech presentation, these parameters include the following:

1. History: when taking the history of the mother, she may complain of feeling pressure or a hard mass under her ribs, especially when she lies down. The pressure felt is as a result of the presence of the fetal head beneath the ribs exerting heavy pressure on the ribs.
2. Abdominal Palpation: when palpating the mother’s abdomen, the head of the fetus is felt at the fundus.
3. Inspection: when inspecting the mother, her uterus appears narrower and longer than normal.
4. Auscultation: when auscultating, the fetal heart sound is heard clearly above the umbilicus.
5. Vaginal Examination: when performing a vaginal examination, the examiner feels the anus, foot or the external genitalia, instead of feeling the sutures of the fetal skull.
6. Ultrasound: this is done to confirm diagnosis
7. X-ray: If the x-ray is done at 36 weeks of gestation, it gives a clear diagnosis of breech presentation.

Read Also: Indications For Caesarean Section

 

How To Manage Breech Delivery

Now that we have known how to diagnose breech presentation, let us take a good look on how to manage a breech delivery.

In managing a breech delivery, a medical practitioner might take the following steps:

• Empty the mother’s bladder before second stage of labour, or before asking her to bear down.
• Place her in lithotomy position with her knees flexed and abducted when the breech is distending the perineum.
• Put birth mackintosh under her and drape appropriately.
• Allow the breech to distend with the uterine contraction and the bearing down effort of the mother
• Check fetal heart after every contraction.

Delivery of Buttocks and the trunk

• Clean the patient up if she defecates and drape her with sterile towel.
• Use your fingers to stretch the vagina and iron the perineum.
• Infiltrate the perineum with local analgesia.
• Perform right medio-lateral episiotomy to prevent pelvic resistance and enable the baby to come through easily.
• Arrest any bleeding with artery forceps.
• Allow delivery of the buttocks to take place with good uterine contraction and maternal effort.
• Assist in freeing the legs.
• Allow the trunk to be born as far as the umbilicus by the effect of further uterine contraction.
• Pull a loop of umbilical cord and bring it to lie in between the baby’s leg.
• Administer general anaesthesia if need be.

Delivery of The Shoulders

• Allow the weight of the buttocks and the trunk to bring the shoulder down to the pelvic floor.
• Grasp the baby at the iliac crests.
• Apply a downward traction as the patient is pushing to aid the expulsion of the shoulder.
• Free the arms when the elbows have come down with uterine contraction; freeing the posterior first.

Delivery of The After Coming Head Using Burn Marshall’s Technique

• Allow the baby to hang down with the back uppermost at the vulva for about two minutes ; this allows the head to be born as far as the nape of the neck.
• Apply a gentle supra pubic pressure to facilitate its descent, if the head does not descend to the pelvis in one or two minutes.
• Grasp the leg of the baby and exert a firm outward traction when the sub occipital area appears at the pubic arch.
• Lift the body towards the mother’s abdomen.
• The fetal head is delivered by a movement of flexion .
• Use your left hand to guard the perineum and to prevent the head from being delivered too quickly.
• Your assistant should suck out all the mucous from the airways when the mouth and nose of the baby is free using mucous extractor.

Complication that Arise in Breech Delivery

Some complications may arise due to breech delivery, causing harm to both the mother and the child. Most of this complications may include the following;

Complications to Mother

• Prolonged labour due to abnormal uterine contractions.
• Exhaustion related to prolonged labour.
• Obstructed labour/impacted breech.
• Intrauterine infection related to manipulative delivery.
• Post-partum haemorrhage.
• Vesico-vaginal fistula(VVF) due to prolonged labour.

 

Complication to baby

• Intra-cranial haemorrhage
• Hypoxia due to cord compression associated with cord prolapse and intra-partum separation of the placenta.
• Soft tissue damage; damage to the liver and the spleen due to squeezing of the abdomen.
• Cord prolapse; due to ill lifting presenting part, more common in flexed or footling breech.
• Dislocation of hip; often occurs in breech extended legs.
• Fracture of the humerus.
• Superficial tissue damage

 

We hope this information was helpful. Feel free to ask us questions in the comment sections.