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Emergency: requires immediate attention
Breech baby injury
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Emergency: requires immediate attention

Breech baby injury

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Contributors: Marika Toscano MD, Mitchell Linder MD
Other Resources UpToDate PubMed

Synopsis

Breech presentation is defined as the fetal buttocks or legs entering the pelvis before the head. Breech presentation persists in 3%-4% of term singleton deliveries. Risk factors include abnormal amniotic fluid volume, multifetal gestation, hydrocephaly / anencephaly, uterine anomalies, placenta previa, fundal placentation, pelvic tumors, prior breech delivery (recurrence rate is 10% in second pregnancy and 27% in third pregnancy), and prior cesarean delivery.

There are 3 types of breech: the complete breech with flexed hips and knees; the incomplete breech with one or both hips partially or fully extended; and the frank breech with flexed hips and extended knees and feet adjacent to fetal head.

Breech presentation can be diagnosed by Leopold maneuvers or vaginal exam with palpation of presenting part; however, sonographic evaluation is the most accurate.

Neonates who are breech in utero are at risk for mild physical deformities (frontal bossing, prominent occiput, upslanting eyes, and low-set ears), torticollis, and developmental dysplasia of the hip.

Vaginal delivery of babies in the breech position may increase the risk of fetal distress, injury, and trauma, resulting in increased neonatal morbidity and mortality. Serious injuries may include hypoxia from cord prolapse upon membrane rupture or from head entrapment during delivery, resulting in neonatal encephalopathy, multiorgan failure or damage, permanent neurodevelopmental deficits, or neonatal / perinatal death. In 5% of breech fetuses, the head may be in extreme hyperextension, resulting in a 25% chance of injury to the spinal cord during attempted vaginal delivery. Severe but rare birth trauma may also include basal skull fracture, subdural hematoma, and intracranial hemorrhage. Less severe injuries from breech delivery may include temporary or permanent brachial plexus injury resulting from nuchal arm, extremity, or clavicular fractures, or genital injuries.

Codes

ICD10CM:
P03.0 – Newborn (suspected to be) affected by breech delivery and extraction

SNOMEDCT:
200142000  – Breech extraction - delivered
56110009 – Birth trauma of fetus

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Injuries related to hypoxia such as neonatal encephalopathy, multiorgan failure or damage, neurodevelopmental delay, or cerebral palsy may also be present from a large number of alternative etiologies in addition to breech delivery, and therefore may be hard to distinguish as specifically related to the breech birth process.
  • Brachial plexus nerve injuries and clavicular or extremity fractures may result from difficult cephalic delivery and are not specific to breech delivery.
  • Injuries to fetal spinal cord during delivery may result from alternative etiologies including atlantoaxial instability associated with Down syndrome, rotational maneuvers during delivery, or difficult cephalic delivery.
  • Developmental dysplasia of the hip may also present in neonates with Ehlers-Danlos syndrome or other connective tissue disorders, Down syndrome, or neuromuscular disorders such as spina bifida or cerebral palsy.
  • Differential diagnosis of congenital torticollis is craniosynostosis.

Best Tests

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Therapy

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References

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Last Reviewed: 11/17/2017
Last Updated: 11/27/2017
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Emergency: requires immediate attention
Breech baby injury
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Breech baby injury : Hypoxemia, Soft tissue swelling, Ecchymosis
Clinical image of Breech baby injury
Bruised legs resulting from double footing breech in premature infant.
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