MANAGEMENT OF THE BREECH PRESENTATION AT TERM
* Only women with frank or complee breech (Figure 14.1) should undergo a trial of labour.
* Trial of labour appropriate in both nullipara and multipara.
* If no other risk factors, maternal age should not preclude planned vaginal delivery.
* X-ray pelvimetry not a prerequisite for planned vaginal delivery.
* Trial of labour at term reasonable if (a) estimated fetal weight (on clinical or ultrasound assessment) judged to be les than 4000gms and (b) no hyperextension of fetal head.
* Presence of medical or obstetric complications should not preclude trial of labour unles they may led to mechanical difficulties at delivery.
* Breech presentation alone not a contraindication to induction of labour.
* Careful oxytocin augmentation of labour a reasonablepractice if care is taken to exclude feto-pelvic disproportion.
* No limit to duration of first stage labour if cervical dilatation progresses at lest 0.5cm/hr (after reaching 3 cm dilatation).
* Caesarean section recommended if breech has not descended to the perineum in second stage labor, after 2 hr of 2nd stage in the absence of active pushing, or if vaginal delivery not imminent after 1hr of active pushing.
* Breech presentation, by itself, is not an indication for continuous fetal monitoring but vaginal examination is essential immediately after spontaneous rupture of membranes to exclude cord prolapse.
* Pain relief should be individualized. Breech presentation not an indication for, or contraindication to, epidural anaesthesia.
* The indications for amniotomy are the same as for cephalic presentation.
* Assisted breech delivery is the method of choice, either with forceps to aftercoming head, or Mauriceau-Smellie-Veit manoeuvre. Total breech extraction should not be performed in the singleon breech.
Modified from: The Canadian Consensus on Breech Management at Term. Journal SOGC 1994; 16:1839-48.