Is normal delivery possible when baby is in breech position? - Dr. Sheela B S

Breech presentation is defined as the fetus is in the longitudinal position with its buttocks or footlings in the lower segment of the uterus and the head towards the fundus. Incidence is about 2 to 3 %. It is commonly seen in conditions like prematurity. I can say extreme prematurity, the fetus is most often in the breech position because of the large size of the fetal head, but later towards the term pregnancy, it turns to cephalic presentation. So prematurity is one important cause for breech deliveries. Next comes the uterine anomalies or the CNS anomalies of the fetus like hydrocephalic head. In conditions like placenta previa where the placenta occupies the lower segment. Another important presentation where we see the breech presentation is the multiple pregnancies there are 3 types of breech presentation. Extended breech, complete breech and footling presentation. Extended breech is the commonest presentations available and it is the most favorable presentation for vaginal delivery. Until 1959, conducting breech delivery was the norm. But there was a very high incidence of perinatal morbidity and mortality. Later it was considered that it went off better anesthetic agents, antibiotics, and surgical skills. It was made mandatory that all breech presentations should be delivered abdominally. But here the incidence of C section went up. Nowadays we are again considering or conducting vaginal delivery to minimize he incidence of Cesarean sections. There are 3 types of vaginal deliveries in breech presentation. First one is spontaneous breech delivery. It is very rare. But it is common in extremely premature or previable babies. So it just comes out and we have to just support the baby. The next one , which is very important and we are considering is the assisted breech delivery. Here the baby is allowed to spontaneously deliver upto the umbilicus and we support the delivery of the shoulder and of the coming head ad these needs an expertise and next comes the breech extraction. Here this particular procedure is done mainly for the second of the tint, when it is presenting by breech. Here the whole hand in presence of anesthesia, the whole hand is inserted into the uterine cavity ad extracted by breech, the whole baby is extracted one time it is rarely done. Should never be tried in single term pregnancies, because the baby’s body comes out through the undilated cervix but the head gets entrapped and leads to the death many at times. When we plan for vaginal delivery in breech presentation. Selection of the case is very very important. So ideal gestational age for vaginal delivery in breech presentation is between 32 to 36 weeks. Before that and after 36 weeks of gestation, they should go for C section. Extended breech is favorable for conducting vaginal delivery. Baby’s weight should be average. Definitely should be 40000 and there should not be any disproportion or the pelvis should be adequate. More important point is the obstetrician who conducts the vaginal delivery should be experienced in the art of conducting vaginal delivery in the breech presentation. If not, then there may be C section may be a better choice in such a hands. So the criteria for delivering vaginally a breech case is selection of the patient, experienced obstetrician who is experienced in conducting vaginal delivery in breech presentation and careful counseling of the parents regarding the risks and benefits of both abdominal, vaginal delivery is considered, then there should not be any hesitation in conducting vaginal delivery in breech presentation and this can definitely prevent the higher incidence of C-sections.

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