Breech Presentation

UNCONTROLLED WHEN PRINTED

Quick Chart

Introduction

Breech presentation means the baby is lying longitudinally with its bottom and/or feet presenting first to the lower part of the mother’s uterus. (RANZCOG, 2016).

Breech occurs in 3-4% of term deliveries and is more common in preterm.

Clinical Presentation

Presentation of any part of the baby other than the head.

Frank breech
Complete breech
Footling breech

Exclusion Criteria

Risk Assessment

Nulliparous women
Previous Breech presentation
Pre-term delivery
Multiple pregnancies
Placenta praevia
Malformation of uterus or foetus
Uterine and congenital abnormalities

Management

Primary Care

Delivery should NOT be attempted unless it is absolutely inevitable
Delivery of a footling breech should NOT be attempted in the pre-hospital setting
Do NOT attempt to push the baby back in or pull on baby

Primary Survey
Offer continuous support and reassurance
Position patient appropriately (being mindful to avoid aortocaval compression)
Perform maternal vital sign survey
Consider oxygen

Intermediate Care (EMT / Level 2)

Apply cardiac monitor if trained and authorised
Consider pain relief; methoxyflurane is not contraindicated in labour, and should only be withheld if the mother gets too drowsy
Consider anti-emetic
If delivery is inevitable:
- Prepare for delivery as per normal birth CPG; position mother in the Lithotomy Position
- Exclude cord prolapse
- If the baby’s head does not deliver spontaneously, a modified Mauriceau Smellie Veit (MSV) manoeuvre may need to be considered.
- Prepare for newborn resuscitation
Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
Transport Priority 1 if patient time critical, pre-notifying receiving facility

Advanced Care (AP)

Apply cardiac monitor if trained and authorised
Establish vascular access
Consider pain relief; methoxyflurane is not contraindicated in labour, and should only be withheld if the mother gets too drowsy
Consider anti-emetic
If delivery is inevitable:
- Prepare for delivery as per normal birth CPG; position mother in the Lithotomy Position
- Exclude cord prolapse
- If the baby’s head does not deliver spontaneously, a modified Mauriceau Smellie Veit (MSV) manoeuvre may need to be considered.
- Prepare for newborn resuscitation
Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
Transport Priority 1 if patient time critical, pre-notifying receiving facility

Critical & Extended Care (CCP, PSO)

As per Advanced Care (AP) guidelines

Additional Information

Significant cord compression is common
Liaise with obstetrics unit in the metropolitan area, recording all advice on ePCR
Liaise with local hospitals in country, recording all advise given on ePCR