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Breech Pregnancy

Thursday, August 23rd 2012. | Pregnancy

Breech Definition

The breech is defined by a delivery of a fetus occurring in the most common position (ie presentation upside down), but with the head up. This child so his “butt” first.

We speak of “full seat” when the fetus is sitting “cross-legged” and “breech” when the fetus has its legs extended in front of him (feet facing his head).

Why is it the fetus in breech?

Many fetuses are breech pregnancy, then increasing the term, the majority of them returning spontaneously, it is called “spontaneous version.”

A little less than 5% of fetuses do not realize this version and thus remain in the seat. The causes are most often benign, harmless (special shape of the uterus, placenta position, presence of fibroids, multiple pregnancies …) or not found (most common case).


Breech Pregnancy

Is it possible to give birth by natural means in the case of breech presentation?

The breech by natural means is possible, but not for one in three women because of precautionary measures implemented to prevent rare but potentially serious complications for the newborn.

To give birth by natural means, several conditions must be met:

  • Have information on the size of the pelvis (pelvis radiography, ie pelvimetry), as well as the size of the fetus (biometrics). In case of anomaly in these tests (fetal weight important pool of sufficient size), a cesarean section is usually proposed.
  • Have been informed about the progress of a breech delivery, and accept the principle.
  • Be motivated to give birth by natural means.

Why not do a cesarean section in all patients with a fetus “under siege”?

A cesarean section is a surgical procedure (see specific issue) is not trivial. Even if the extreme majority of caesarean happen without any complication, it remains an invasive procedure may be complicated. In addition, it causes a scar on the uterus, which is weakened in subsequent pregnancies. This does not give birth by natural means, but it significantly increases the cesarean rate for the next pregnancy. Finally, having a scarred uterus is a higher risk of bleeding following childbirth and requires closer monitoring.

Practitioners therefore opt for the solution with the least risk to their patients and their unborn children.

Although some practitioners perform a cesarean systematic in their patients with a fetus in breech, there are currently no recommendations regarding the breech.

Why not “help the baby turn?”

The practitioner may suggest that you return to your baby, it is the version with external maneuvers (VME) .

This gesture is available if your baby is still breech at around 36-37 SA. For this, the practitioner will try to turn the baby by placing her hands on your stomach and put pressure favoring version. The VME is generally not painful but quite rude and only takes a few minutes.

This action allows the baby to pay a little less than half of the cases.

If this action has not been successful, the practitioner will discuss with you the type of delivery, while informing you that it will be necessary to have all the requirements to “try” a natural vaginal delivery.

Some cons-indications exist as to the VME having a fetus with growth retardation, placenta inserted “low” in the womb, etc …

Finally, you should know that the VME requires special precautions. Thus, the team will record the heartbeat of your baby before and after the procedure. In addition, if your blood group is Rhesus negative injection is required (gamma globulin).

How does one breech?

If the delivery takes place by natural means, the work place as a fetus presenting “the head.” The work must be fast and cervical dilatation should be regularly without stagnation.

At the time of expulsion, delivery may be spontaneous or require maneuvers why the entire obstetric team will be present.

Even if all the conditions are met to give birth by natural means, a cesarean section is possible at any time from work.

If it is a cesarean delivery, it runs like any other cesarean.The obstetrician will perform maneuvers only adapted to extract your baby considering its position. The rest of the document is identical in all respects to a caesarean “classic”.


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