7. CONDITION: Singleton Breech Presentation
A. When the presence of a breech presentation is identified, the patient may be offered the option of external version with the risks being discussed.
B. Cesarean section is currently the most common method for delivery in breech presentation unless delivery is imminent.
C. When a vaginal breech delivery is considered, the physician should inform patient as to which method of delivery is considered best on the basis of the clinical situation and the circumstances of support facilities and personnel.
D. Facilities should include the capability of emergency Cesarean section.
E. The physician must have experience with vaginal breech delivery.
F. Anesthesia personnel should be present for delivery.
G. Presentation should be that of a frank breech. Any other presentation requires further evaluation.
H. The fetal weight should be estimated at less than 4,000 gm.
I. Hyperextension or macrocephaly should be ruled out by clinical examination or appropriate diagnostic imaging.
J. Pelvic size should be adequate and is usually determined by pelvimetry, clinically and/or radiographically.
K. There should be adequate progression of labor in dilation, effacement and descent.
L. Intravenous lines along with facilities for maternal surgery and transfusion should be in place.
M. Fetal heart monitoring is required.
N. Local, pudendal, regional and general anesthesia are all used in breech presentation deliveries.
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