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Course of labor in breech presentation
Last reviewed: 04.07.2025

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Childbirth with a breech presentation of the fetus is most often complicated by:
- premature or early rupture of membranes, prolapse of umbilical cord loops;
- weakness of labor;
- fetal asphyxia;
- unpreparedness of the soft tissues of the birth canal for the passage of the head.
Due to the peculiarities of the course of labor in breech presentations of the fetus, it is necessary to carry out the following measures: prevention of untimely rupture of amniotic fluid; early detection of labor anomalies and their timely treatment; provision of manual assistance during labor according to N.A. Tsovyanov and classical manual assistance.
The mechanism of labor in breech presentation differs from that in cephalic presentation, but the principle of adaptation of the presenting part to the birth canal remains the same.
The buttocks are smaller in volume than the head, but they are still a large part of the mother's pelvis. The largest size of the buttocks will be the distance between the greater trochanters. This size, like the sagittal suture in cephalic presentation, is established at the entrance of the normal pelvis in an oblique size. The anterior buttock is the first to descend into the small pelvis, becoming the leading point. Thus, a moment occurs that can be likened to sacral rotation in cephalic presentation.
When the largest volume (segment) of the buttocks has passed the pelvic entrance, the latter perform an internal rotation in the pelvic cavity in such a way that the anterior buttock approaches the pubis and is pulled forward, and the posterior one goes to the sacrum; lin. inteitrochanterica is established on the pelvic floor in the direct size of the exit.
As for the cutting in and cutting out of the buttocks, this moment is accomplished in the following way. The anterior buttock comes out from under the symphysis, the fetus's pelvis rests on the pubic arch with its ilium (fixation point) and only then the posterior buttock is born. At the same time, a strong lateral bending of the lumbar spine along the pelvic axis occurs, similar to the extension of the head.
When the posterior buttock is completely delivered, the spinal arch straightens, releasing the rest of the anterior buttock. The legs are either also released at this time, if they go together with the buttocks, or are retained in the birth canal, if they are extended, which is usually observed in a pure breech presentation. In the latter case, the legs are delivered during the next contractions. After birth, the buttocks perform an external rotation (like the head) in accordance with the position of the overlying shoulders. Lin. intertrochanterica is established in the same size as the shoulders. The birth of the trunk from the buttocks to the shoulder girdle is accomplished easily, since this part of the body is easily compressed and adapted to the birth canal. At the same time, the umbilical ring appears, and the umbilical cord is pressed to the trunk by the muscles of the pelvic floor.
The passage of the shoulder girdle through the birth canal is accomplished in the same way as the passage of the pelvic end. The biacromial size of the shoulders cannot be established in the direct size of the exit. The anterior acromion is released from under the pubis, as a result of which the cervical-humeral angle (fixation point) is established under it, and only after this the posterior shoulder is released. In this case, the arms are born easily if they retain a normal articular arrangement, or are delayed when extended along the head or thrown back behind it. Extended or thrown back arms can be released only by obstetric techniques. The born shoulders, in accordance with the mechanism of passage through the pelvis of the subsequent head, perform an external rotation to an oblique size opposite to that in which the sagittal suture is located.
At birth, the head bends at the entrance to the pelvis, into which it enters at an oblique angle; an internal rotation follows in the pelvic cavity, cutting through a larger circle corresponding to the diameter of the suboccipito-frontalis.
The point of fixation is the suboccipital fossa, with the occipital protuberance positioned above the pubis; the head bends, the chin is born first, the occipital protuberance last.
Every obstetrician must be able to provide assistance during breech birth. The obstetrician must remember that the dangerous period threatening the fetus begins from the moment when the lower angle of the scapula appears from the genital slit. At this point, a delay in labor, even for a short period, on average not exceeding 5 minutes, is fatal for the fetus. This danger can arise even from the moment the umbilical ring appears from the genital slit due to compression of the umbilical cord. The life of the fetus is especially threatened during passage through the pelvic outlet of the shoulder girdle, when the head enters the cavity of the small pelvis.