1. Breech presentation occurs in about 2 to 4 % of singelton deliveries at term and more frequently in the early third and second trimester

2. The conditions associated with breech presentation:
prematurity
multiple pregnancy
polyhydramnios
hydrocephaly
anencephaly
uterine anomalies
uterine tumors
placenta previa

3. Kinds of breech presentation:
complete
incomplete
frank footling single or double kneeling single or double

4. Diagnose:
Leopold maneuvers
pelvic examination
ultrasonography

5. In the cephalic presentation the largest part of the fetal body (head) is delivered at first. It lasts usually from 30 minutes to 2 hours. After the delivery of the head the rest part of the body which is smaller is delivered without problems. In the breech presentation the smaller part of the fetus (pelvis) deliveries at first. Then the bigger part of the body (head) has to pass through the birth canal in a very short time (1-2 minutes) because of the compression of the umbilical cord between the head and the bony pelvis.

6. The morbidity and mortality rates for mothers and fetuses, regardless to gestational age or mode of delivery, are higher in the breech than in the cephalic presentation. This increased risk of the fetus comes from associated factors such as fetal anomaly, prematurity and umbilical cord prolapse as well as birth trauma.

7. Contraindications for vaginal delivery in breech presentation (because of the increased risk of birth injury):
preterm fetus weighting < 2000 g
fetus weighting > 4000 g
pelvic abnormalities
breech presentation in primiparas
hyperextension of the fetal head (5%)
footling breech In these situations we perform elective cesarean section

8. The suggested criteria for a vaginal breech delivery:
a normal labor curve (normal rate of the dilatation of the cervix and descending of the presenting part without the necessity of stimulating uterine action)
estimated fetal weight between 2000 and 4000 g
doubtless fetal heart trackings
an adequate maternal pelvis by clinical pelvimetry
a normally flexed head

9. The key to successful vaginal delivery in breech presentation is not to rush the process, allowing spontaneous delivery as much as possible before intervention.

10. Sometimes in breech presentation it is possible to perform external cephalic version which avoids the neccessity of cesarean section. selection criteria for this version include: - a normal fetus with reassuring fetal heart trackings - adequate amniotic fluid - presenting part not in pelvis - no uterine operative history - no labor

11. The potential risk include:
placental abruption
cord accident
uterine rupture In our Clinic we don’t use the technique of external version

12. When the fetus is delivered spontaneously to the level of the lower angles of the scapule the obstetrician finishes the labor by use of maneuver called manual assistance. The best mode of this assistance is the maneuver of Bracht