From the Guidelines
Breech delivery complications can be minimized with a planned cesarean section, which is the safest approach for most breech presentations. The complications associated with breech deliveries are numerous and can be serious, including head entrapment, umbilical cord prolapse, birth trauma, birth asphyxia, and increased maternal bleeding. According to a recent meta-analysis of 43,611 deliveries of women with schizophrenia and 40,948,272 controls, the odds ratio for cesarean section was 1.33 (1.22-1.45) 1. This suggests that cesarean section is a common outcome in complicated deliveries, including breech presentations.
Key Considerations
- Common complications of breech deliveries include:
- Head entrapment
- Umbilical cord prolapse
- Birth trauma (including brachial plexus injuries, fractures, and intracranial hemorrhage)
- Birth asphyxia
- Increased maternal bleeding
- Planned cesarean section can significantly reduce these risks
- External cephalic version (ECV) may be attempted at 36-38 weeks gestation to convert the baby to a head-down position, with a 40-60% success rate
Management
- Healthcare providers should be prepared for complications with specialized maneuvers such as Mauriceau-Smellie-Veit maneuver for head entrapment and Lovset's maneuver for arm delivery
- Neonatal resuscitation equipment should be immediately available
- Early identification through ultrasound screening allows for proper delivery planning to minimize potentially serious complications, as seen in the study by 1.
From the Research
Breech Delivery Complications
- Breech presentation is the most common abnormal fetal presentation and complicates approximately 3% to 4% of all pregnancies 2.
- The risks associated with breech delivery include perinatal mortality, birth trauma, and Apgar scores lower than 7, which are higher in planned vaginal delivery compared to planned caesarean section 3.
- Factors associated with higher risk of adverse fetal or neonatal outcome at term during vaginal breech delivery include:
- Footling presentation
- Hyperextended head
- Fetal weight <2500 g or >4000 g
- Prolonged labor
- Lack of experienced clinician at vaginal breech birth 4.
- External cephalic version (ECV) is a procedure that can reduce the need for cesarean delivery by rotating the fetus from a breech presentation to a vertex presentation, with a success rate of approximately 60% 5, 2.
- ECV should be recommended to women with a breech singleton pregnancy, if there is no maternal or fetal contraindication, and can produce considerable cost savings in the management of the breech fetus at term 5, 2.
- The use of ECV can decrease the rate of cesarean delivery by almost 40% 2.
- Planned caesarean section is significantly better for the singleton fetus in breech presentation at term compared to planned vaginal birth, but some women may wish to avoid cesarean section or may not have access to it 4.