Learning Objectives
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Identify indication for breech extraction.
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Describe technique for breech extraction.
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Identify potential difficulties encountered during breech extraction
Breech extraction has been performed for a long time with different results among the operators. It is usually used to describe the delivery of the second twin with vertex-breech presentations. Breech extraction is preferred over passive delivery of a breech second twin. It is reasonable to avoid the procedure when the weight of the second twin is either <1500 or >4000 g, and when the second twin is much larger than the first twin. Of course, the experience of the operator is paramount to its success. Following the delivery of the first twin, the following steps are used for the breech delivery of the second twin:
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With ultrasound assess (a) the heart rate and (b) the presentation of the second twin
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Inform the patient on the steps for the delivery of the twin
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Do not rupture the membranes yet
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Place a hand in vagina and grasp the feet as in Fig 12.1 (it is important to differentiate between hands and feet)
Fig. 12.1
To begin a breech extraction, the provider grasps the baby’s feet.
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Pull the feet through the vagina and vulva. There will be fetal resistance that is proportional to fetal weight ( Fig. 12.2 )
Fig. 12.2
(A) One or (B) both of the baby’s feet are grasped with the provider’s hand and pulled through the vagina.
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Continue with gentle extraction and deliver legs, thighs, and buttocks ( Fig. 12.3 )
Fig. 12.3
Following the delivery of the baby’s torso, the remainder of the breech extraction continues according to the instructions for breech delivery described in the previous chapter.
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Continue with the delivery as reported in Figure 11.6 , Figure 11.7
It is preferable that the membranes are ruptured following the delivery of the lower extremities. However, if they rupture earlier, that is not a problem.
Usually, the back of the fetus rotates anteriorly.
If the back rotates posteriorly, following delivery of the upper extremities, the fetus is elevated toward the maternal abdomen with one hand; two fingers of the other hand are placed around the neck and above the shoulders (Prague maneuver) and the fetus is delivered, as is detailed in Fig. 12.4 .
What Can Go Wrong That Ought to Be Corrected?
Nuchal Arm
One or both arms may be found around the back of the neck .
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