Overview & Nursing Role in Breech; Types of Breech Presentation; Predisposing Factors & Diagnosis; External Cephalic Version (ECV); Potential Complications of Breech Birth

Physiology of Breech Presentation

Physiology of Breech Presentation

Understanding breech for safe maternal and fetal outcomes in nursing practice.

Agenda

• Overview & Nursing Role in Breech

• Types of Breech Presentation

• Predisposing Factors & Diagnosis

• External Cephalic Version (ECV)

• Potential Complications of Breech Birth

Breech Presentation: Overview

Breech presentation occurs when the fetus lies longitudinally with the buttocks or feet presenting first. This occurs in approximately 3-4% of term pregnancies and is a significant variant in obstetric management. Understanding its types and implications is crucial for safe maternal and fetal outcomes.

Fetal anatomy diagram showing breech presentation variations.

Nursing Role in Breech

Nurses are crucial in identifying breech presentations, often through Leopold's maneuvers or reviewing ultrasound findings. They continuously monitor maternal and fetal well-being, providing vital support during management decisions. Patient education, like explaining ECV procedures, is also a core responsibility.

Nurses identify breech presentation using fetal anatomy knowledge.

Fetal Lie and Presentation

• Fetal Lie: Relationship of fetal long axis to maternal long axis.

• Types of Lie: Longitudinal, transverse, and oblique.

• Fetal Presentation: Fetal part closest to maternal pelvic inlet.

• Breech: A longitudinal lie with the pelvic pole presenting.

Frank Breech Characteristics

Frank breech is the most common type, where the fetal hips are flexed and knees extended, with the buttocks presenting. Imagine the baby's legs straight up towards its head. This presentation accounts for approximately 65-70% of all breech cases, making it crucial for nurses to identify.

Fetal skeleton development: Frank breech presentation.

Complete Breech Explained

In a complete breech presentation, both the fetal hips and knees are fully flexed. This means the baby's buttocks are presenting towards the cervix, with the feet positioned alongside the buttocks. It resembles a 'squatting' position within the uterus.

Incomplete &amp; Footling

In an incomplete breech presentation, one or both of the baby's hips are extended, allowing one or both feet to be positioned near the cervix. Footling breech is a specific type where one or both feet present first through the cervix, rather than the buttocks. Both incomplete and footling breeches carry higher risks, such as cord prolapse, due to the less optimal presenting part for cervical dilation and descent.

Frank &amp; Complete Breech

Incomplete &amp; Footling Breech

Frank breech, the most common type, involves the fetus having flexed hips and extended knees, presenting the buttocks. In a complete breech, both the hips and knees are flexed, with the baby's legs crossed. These positions require careful assessment of fetal well-being and labor progression.

Incomplete breech occurs when one or both hips are extended, and a knee or foot presents first. Footling breech is a specific incomplete type where one or both feet are the lowest presenting part. These variations significantly increase the risk for umbilical cord prolapse during labor.

Factors for Breech

• Uterine anomalies: bicornuate, arcuate uterus.

• Prematurity: insufficient time for cephalic version.

• Multiple gestation or polyhydramnios: increased space.

• Placenta previa obstructs fetal head engagement.

Physiology of Breech Presentation

Overview & Nursing Role in Breech; Types of Breech Presentation; Predisposing Factors & Diagnosis; External Cephalic Version (ECV); Potential Complications of Breech Birth

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