It has significant implications in terms of delivery - especially if it occurs at term (>37 weeks). The delivery of the aftercoming head can be challenging, but if MSV fails forceps can be used.Ī breech presentation is when the fetus presents buttocks or feet first (rather than head first - a cephalic presentation).Using the Mauriceau-Smellie-Veit (MSV) manoeuvre to deliver the head by flexion.Using Lovsett’s manoeuvre to rotate the body and deliver the shoulders.Flexing the fetal knees to enable delivery of the legs.
However, occasionally the baby does not deliver spontaneously, and some specific manoeuvres are required: The fetal sacrum does need to be maintained anteriorly, which can be done by holding the fetal pelvis. This is because putting traction on the baby during delivery can cause the fetal head to extend, getting it trapped during delivery. The most important advice when conducting a vaginal breech delivery is “ hand off the breech”. Additionally, a small proportion of women with breech presentation present in advanced labour – with vaginal delivery the only option.Ī contraindication to vaginal breech delivery is footling breech, as the feet and legs can slip through a non-fully dilated cervix, and the shoulders or head can then become trapped. Vaginal Breech BirthĪ woman may still choose to aim for a vaginal breech delivery. The evidence for preterm babies is less clear, but generally C/S is preferred due to the increased head to abdominal circumference ratio in preterm babies. There is no significant difference in maternal outcomes between the two groups. This is based on evidence that perinatal morbidity and mortality is higher in cases of planned vaginal breech birth (compared to Caesarean) in term babies. If the external cephalic version is unsuccessful, contraindicated, or declined by the woman, current UK guidelines advise an elective Caesarean delivery. Women should be informed that ECV after one Caesarean section delivery has no greater risk compared to ECV performed on an unscarred uterus.įig 2 – External cephalic version. There is no consensus on the contraindications to ECV. The risk of the woman needing an emergency Caesarean is around 1/200. In primiparous women, ECV can be offered from 36 weeks gestation.Ĭomplications of ECV include transient fetal heart abnormalities (which revert to normal), and rarer complications such as more persistent heart rate abnormalities (e.g fetal bradycardia), and placental abruption. In contrast, only 10% of breech presentations spontaneously revert to cephalic in primiparous women.ĮCV should be offered from 37 weeks gestation. It has an approximate 50% success rate (40% success rate in a primiparous woman, and a 60% success rate in a multiparous woman). This, if successful, can enable an attempt at vaginal delivery.
External Cephalic VersionĮxternal cephalic version is the manipulation of the fetus to a cephalic presentation through the maternal abdomen. At term, the options for management of breech presentation are (i) external cephalic version (ii) Caesarean section or iii) vaginal breech birth.
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