Adhi Pribadi, dr., SpOG(K)

Department of Obstetrics & GynecologyMedicine School of Padjadjaran University

Bandung

MECHANISM OF LABORMECHANISM OF LABORININ

BREECH PRESENTATIONBREECH PRESENTATION

PREDISPOSING FACTORS :

Prematurity Uterine abnormalities : Malformation;

Fieroids Fetal abnormalities : CNS,

Malformations; Neck Masses Multiple gestations

Figure 21-1.Figure 21-1. Types of breech presentations. (Reproduced, Types of breech presentations. (Reproduced,With permission, from Benson RC: With permission, from Benson RC: Handbook of Obstetrics Handbook of Obstetrics & Gynecology& Gynecology, 8, 8thth ed. Lange, 1983) ed. Lange, 1983)

DIAGNOSIS :

Palpation and Palpation and ballottementballottement

Ultrasound Ultrasound Pelvic examinationPelvic examination X-Ray studiesX-Ray studies

Leopold Maneuver

External Cephalic Version

TT

Figure 21-2.Figure 21-2. Breech presentations. A: Right sacrum posterior (RSP) position. B: Left sacrum Breech presentations. A: Right sacrum posterior (RSP) position. B: Left sacrum anterior (LSA) position. (Redrawn and reproduced, with permission, from Bumm E: anterior (LSA) position. (Redrawn and reproduced, with permission, from Bumm E: Grundiss zum Grundiss zum Studium der GeburtshilfeStudium der Geburtshilfe. Bergmann, 1922). Bergmann, 1922)

MANAGEMENT DURING LABOR

Type of DeliveryType of Delivery Cesarean of deliveryCesarean of delivery Vaginal delivery:Vaginal delivery:

SpontaneousSpontaneous Partial breech extractionPartial breech extraction Total breech extractionTotal breech extraction

Mechanism of Labor in Breech Delivery

Assisted Delivery of Frank Breech

Assisted Delivery of Frank Breech

Assisted Delivery of Frank Breech

Assisted Delivery of Frank Breech

Assisted Delivery of Frank Breech

Assisted Delivery of Frank Breech

Assisted Delivery of Frank Breech

Mechanism of Labor in Breech Delivery

Figure 21-5.Figure 21-5. Maneuver for delivery of the head. The fingers of the left hand Maneuver for delivery of the head. The fingers of the left hand are inserted into the infant’s mouth of over mandible; the right hand exerts are inserted into the infant’s mouth of over mandible; the right hand exerts pressure on the head from above. (Modified and reproduced, with pressure on the head from above. (Modified and reproduced, with permission, from Benson RC:permission, from Benson RC:Handbook of Obstetrics & Gynecology, Handbook of Obstetrics & Gynecology, 88thth ed. ed. Lange, 1983)Lange, 1983)

Mauriceau Maneuver

Delivery of the Aftercoming Head

Piper forcepsPiper forceps Modified prague maneuverModified prague maneuver

Forceps to Aftercoming Head

Mechanism of Labor in Breech Delivery

Figure 21-12.Figure 21-12. Application of Piper forceps, employing towel sling support. The forceps are Application of Piper forceps, employing towel sling support. The forceps are introduced from below, left blade first. Aiming directly and intended positions on sides of introduced from below, left blade first. Aiming directly and intended positions on sides of the head. (Reproduced, with permission, from Benson RC:the head. (Reproduced, with permission, from Benson RC:Handbook of Obstetrics & Handbook of Obstetrics & Gynecology, Gynecology, 88thth ed. Lange, 1983) ed. Lange, 1983)

Forceps to Aftercoming Head

Modified Prague Maneuver

Complete or Incomplete Breech Extraction

Complete or Incomplete Breech Extraction

Complete or Incomplete Breech Extraction

Complete or Incomplete Breech Extraction

Breech Extraction

Section Indication

A large fetus ( > 3.500 gr )A large fetus ( > 3.500 gr ) A Hyperextended fetusA Hyperextended fetus Uterine dysfunctionUterine dysfunction Footling presentationFootling presentation Any degree of contraction or un Any degree of contraction or un

favorable shape restrictionfavorable shape restriction Previous perinatal death or children Previous perinatal death or children

suffering from birth traumasuffering from birth trauma

COMPLICATIONS

1. Perinatal morbidity and mortality from difficult 1. Perinatal morbidity and mortality from difficult deliverydelivery

2. Low birthweight from preterm delivery, growth 2. Low birthweight from preterm delivery, growth restriction, or bothrestriction, or both

3. Prolapsed cord3. Prolapsed cord4. Placenta previa4. Placenta previa5. Fetal, neonatal, and infant anomalies5. Fetal, neonatal, and infant anomalies6. Uterine anomalies and tumors6. Uterine anomalies and tumors7. Multiple fetuses7. Multiple fetuses8. Operative intervention, especially cesarean 8. Operative intervention, especially cesarean

deliverydelivery