Obstetrics and Gynecology - A. M. Gromova 2000

Breech presentation. Course of pregnancy and childbirth
Features of the course and management of labor in breech presentations
Classical manual aid in breech presentation

Sometimes during the management of breech delivery, a complication such as arm entrapment may occur. There are three degrees of fetal arm entrapment. When this complication arises, classical manual aid is employed. Manual aid begins with the release of the fetal arms; by this point, the fetus must be born up to the lower angle of the anterior scapula.

The posterior arm is always released first because it is more accessible from the perineal side. To achieve this, both fetal legs are grasped with one hand and the torso is directed upward and to the side until the legs lie parallel to the inguinal fold opposite to the side of the arm being freed. After this, two fingers of the second hand are inserted into the birth canal along the fetal back and, by pressing on the cubital fossa, the posterior arm is delivered. Concurrently with the delivery of the posterior arm, the anterior one often births spontaneously. If this does not happen, the anterior arm is converted into the posterior one by guiding the fetus by its back under the Pubic Symphysis, and it is released using the method described above.

To deliver the HEAD, the Mauriceau-Smellie-Veit maneuver is used. Following the birth of the arms, the infant is "sat astride" the forearm corresponding to the position (for the first position – on the left forearm, for the second – on the right); the index finger of this hand is inserted into the infant's Mouth, which faces the right or left pelvic wall, and the chin is gently pressed toward the chest. With the index and middle fingers of the other hand bent in a fork-like fashion and placed on the infant's shoulders on either side of the neck, the head is tractioned in the direction of the birth canal (the pelvic axis). It is preferable for an assistant to gently press on the head from above the pubic bone simultaneously. When the suboccipital fossa reaches under the pubic arch and the mouth appears at the introitus, the fetal torso is lifted upward, and the chin, face, forehead, and vertex are delivered over the Perineum. In this case, the largest diameter of head engagement will be the small or medium oblique (9-10 cm).

Control Questions

1. What is breech presentation?

2. Causes of breech presentation.

3. Classification of breech presentations.

4. Diagnosis of Breech Presentations.

5. Clinical Features of Pregnancy progression.

6. Main elements of corrective gymnastics according to I.I. Hryshchenko and A.Ye. Shelevnova.

7. What is The Essence of corrective gymnastics according to I.F. Dykan and B.G. Kayo?

8. Tactics of performing the external prophylactic version according to B.A. Arkhangelsky.

9. Management specifics for pregnant women with fetal breech presentation.

10. Biomechanism of Labor in Breech Presentations.

11. Clinical course and Management of Labor in breech presentations.

12. Management of laboring according to Tsovianov's method in frank breech presentation.

13. Management of labor in footling presentations.

14. Classical manual aid in breech presentations.

15. When is the Mauriceau-Smellie-Veit maneuver applied?