Breech delivery: breech presentation causes, types and injuries

If the buttocks are delivered first it is called as breech delivery. only 3 to 4% pregnancies are with breech presentation at birth. Breech position is an abnormal position and vertex presentation is normal birth presentation.

Most breech birth or breech presentation occur at the 32 week of gestation and at this time head of fetus is not turned down.  The main causes of breech presentation or birth are

  • Prematurity is the main cause of breech presentation. Increased amniotic fluid or polyhydraminos,
  • Fetal abnormalities such as hydrocephaly, anencephaly, and congenital abnormalities of fetus,
  • Maternal abnormalities such as Uterine abnormalities.
  • Placental abnormalities, Uterine fibroid and
  • Multiple pregnancy.

Types of breech presentation are

  • Frank breech presentation : baby’s buttocks comes first, and breech baby’s legs are flexed at the hip and extended at the knees (with feet near the ears). Nearly 65 to 70% of breech  delivery are in the frank breech position.
  • Complete breech delivery: the baby’s hips and knees are flexed so that the baby is sitting cross legged, with feet beside the bottom. This is not common as frank breech position.
  • Footling breech delivery : one or both feet come first, with the bottom at a higher position. This is footling breech position is rare at term but relatively common with premature fetuses.
  • * Kneeling breech delivery :  The breech baby is in a kneeling position, with one or both legs of breech baby are extended at the hips and flexed at the knees. This Kneeling breech delivery position is not common type of breech delivery.

Common injuries to breech babies during breech delivery

Umbilical cord prolapse : Is the common abnormality of breech delivery. As soon as the amniotic sac ruptures, the umbilical cord expels out. Due to umbilical cord prolapse the breech babies  receives less oxygen and becomes oxygen deprived.

Head injury : Injury to fetal skull or brain occurs as the late coming head of baby struggles to come out of maternal pelvis. Cranial lacerations, and intracranial hemorrhage may occur. Squeezing of abdomen causes damage to internal organs of breech baby.

Severe hemorrhage is the main complication to mother. Breech birth or breech delivery is one of the causes of maternal mortality. Hysterectomy is indicated in some mothers when uterine rapture occurs. External cephalic version is done in some mothers before labor starts.

Even most of the experienced doctors have stopped conducting birth canal breech delivery and they will plan for cesarean section to prevent injury to new born baby and to avoid maternal complications. It is confirmed that elective cesarean section is done by concerning fetal and maternal well being.

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