eMedicine Specialties > Emergency Medicine > Obstetrics & Gynecology

Pregnancy, Breech Delivery: Follow-up

Author: Andrew D Jenis, MD, Chair, Department of Emergency Medicine, Cortland Regional Medical Center
Contributor Information and Disclosures

Updated: Oct 26, 2009

Follow-up

Further Inpatient Care

  • Warm and dry the infant. Place him or her in an infant incubator.
  • If the infant is younger than 37 weeks' gestation, the lungs may be premature. Consider endotracheal intubation with mechanical ventilation.
  • Even in infants older than 37 weeks' gestation, the infant still should be placed in a hospital with a nursery.
  • Inspect the maternal birth canal, and repair lacerations of the cervix and vagina, as required.

Inpatient & Outpatient Medications

  • Administer 300 mcg RhoGAM IM if the mother is Rh negative.

Transfer

  • When stable, transfer the infant to the nearest hospital with pediatric intensive care. Otherwise, transfer the infant and mother to a hospital with newborn facilities.

Complications

  • Traumatic mortality to the fetus is 12 times more likely.
  • Intracranial fetal hemorrhage is the most common injury in breech delivery.
  • In decreasing order of frequency, the spinal cord, liver, adrenals, and spleen also are injured.

Prognosis

  • Fetal and maternal morbidity and mortality increase with breech delivery.
  • Maternal: A rise in the number of cesarean deliveries increases the maternal morbidity and mortality (eg, wound infection, aspiration, anesthesia risk), especially with emergency delivery.
    • Fetus and infant mortality increases to 9%, compared with 3% in cephalic presentations.
    • Average Apgar score, especially at 1 minute, is lower.
    • Congenital abnormalities increase to 6%, compared with 2.4% in infants with cephalic presentations.
    • Factors for increased adverse fetal outcome include the following:1
      • Older mothers
      • Footling presentation
      • Hyperextended fetal head
      • Birth weight less than 2500 g or greater than 4000 g
      • Prolonged labor
      • Nonexperienced clinician

Patient Education

  • Early prenatal care can identify patients at risk for breech delivery.

Miscellaneous

Medicolegal Pitfalls

  • Beginning extraction of fetus prior to complete descent
  • Failure to have neonatal and maternal resuscitation equipment ready prior to extraction
  • Late consultation of obstetrics and neonatology personnel
  • Transfer of mother in active labor, of mother or infant in an unstable condition, or both (See the eMedicine article, COBRA Laws and EMTALA.)
 


More on Pregnancy, Breech Delivery

Overview: Pregnancy, Breech Delivery
Differential Diagnoses & Workup: Pregnancy, Breech Delivery
Treatment & Medication: Pregnancy, Breech Delivery
Follow-up: Pregnancy, Breech Delivery
Multimedia: Pregnancy, Breech Delivery
References
[ CLOSE WINDOW ]

References

  1. Tunde-Byass MO, Hannah ME. Breech vaginal delivery at or near term. Semin Perinatol. Feb 2003;27(1):34-45. [Medline].

  2. Alarab M, Regan C, O'Connell MP, Keane DP, O'Herlihy C, Foley ME. Singleton vaginal breech delivery at term: still a safe option. Obstet Gynecol. Mar 2004;103(3):407-12. [Medline].

  3. Carbillon L. Vaginal versus cesarean delivery for breech presentation in California: a population-based study. Obstet Gynecol. May 2004;103(5 Pt 1):1003-4. [Medline].

  4. Cunningham FG, Gant FG, Leveno KJ. Breech Presentation and Delivery (Chapter 22). In: Williams Obstetrics. ed. 2001.

  5. Ghosh MK. Breech presentation: evolution of management. J Reprod Med. Feb 2005;50(2):108-16. [Medline].

  6. Gilbert WM, Hicks SM, Boe NM, Danielsen B. Vaginal versus cesarean delivery for breech presentation in California: a population-based study. Obstet Gynecol. Nov 2003;102(5 Pt 1):911-7. [Medline].

  7. Roberts JR, Hedges JR. Emergency childbirth. In: Clinical Procedures in Emergency Medicine. 3rd ed. 1997:chap75, 1000-1003.

  8. Scorza WE. Intrapartum management of breech presentation. Clin Perinatol. Mar 1996;23(1):31-49. [Medline].

  9. Stitely ML, Gherman RB. Labor with abnormal presentation and position. Obstet Gynecol Clin North Am. Jun 2005;32(2):165-79. [Medline].

  10. Warke HS, Saraogi RM, Sanjanwalla SM. Should a preterm breech go for vaginal delivery or caesarean section. J Postgrad Med. Jan-Mar 1999;45(1):1-4. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

breech presentation, breech pregnancy, breech birth, buttocks first, feet first, frank breech presentation, full breech presentation, complete breech presentation, incomplete breech presentation, single footling breech presentation, double footling breech presentation, breech delivery

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Andrew D Jenis, MD, Chair, Department of Emergency Medicine, Cortland Regional Medical Center
Andrew D Jenis, MD is a member of the following medical societies: American College of Emergency Physicians and Medical Society of the State of New York
Disclosure: Nothing to disclose.

Medical Editor

Assaad J Sayah, MD, Chief, Department of Emergency Medicine, Cambridge Health Alliance
Assaad J Sayah, MD is a member of the following medical societies: National Association of EMS Physicians
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Mark Zwanger, MD, MBA, Assistant Professor, Department of Emergency Medicine, Thomas Jefferson University
Mark Zwanger, MD, MBA is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and American Medical Association
Disclosure: Medicines Company Consulting fee Consulting; Pfizer Salary Employment

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Pamela L Dyne, MD, Professor of Clinical Medicine/Emergency Medicine, David Geffen School of Medicine at UCLA; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center
Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.