December 21, 2009


Case: Breech


a) Causes and complication of breech

b) Management, mode of delivery and time of delivery for breech.

c) ATT- Type of immune


It is the most common type of malpresentation. Presentation of the fetal buttocks and feet in labour

Incidence: 26W 40%, 30W 20%, term 3%

Type: Extended, Flexed, Footling


1) Multiparous woman with lax uterus and abdomen

2) Prematurity

3) Fetal structural anomalies; anencephaly, hydrocephalus

4) Uterine anomalies; uterus bicornu, fibroids

5) Multiple gestation; twins

6) Hydramnios; oligo or poly

7) Placenta previa

8) Contracted maternal pelvis

9) Pelvic tumours



2) Cord prolapsed [common in footling presentation and lesser in flexed breech presentation]

3) Difficulty in delivering the shoulder

4) Difficulty in delivering the head[ may lead to intracranial bleeding d/t tear of tentorium or delay delivery of head can cause prolonged compression of cord and asphyxia]

5) Birth trauma such as fracture, viscera damage, Erb Duchenne paralysis, dislocation of hip joint.

Mode and timing of delivery



28-32 weeks, weight 1.0 - 1.5 kg


32-37 weeks Weight 1.5 – 2.5 kg

Depend on case

1) Assisted breech delivery for Extended and flexed

2) LSCS for footling breech

> 37 weeks

Preferably Caesarean section


Tetanus vaccine is an inactivated toxin (toxoid) made by growing the bacteria in a liquid medium and purifying and inactivating the toxin.

Type II Immune response

It is administer once the quickening felt and can be repeated 2-3 months after first injection in primid women as a booster injection. (Usually 5th and 7th months of pregnancy)

Notes: It is different from Anti tetanus human immunoglobulin which are preparation containing IgG immunoglobulin derived from plasma of donors sensitized to tetanus toxoid. it acts by The IgG antibodies acts to neutralize the free circulating exotoxisn of clostridium tetani and prevent its fixation in tissue and its consequences.

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