ED Mx of emergency breech delivery

3-4% of all deliveries (7% of 32wk & 25% of 28wk deliveries)
factors associated:
- polyhydramnios, oligohydramnios, hydrocephalus, previous breech, pelvic tumours, uterine anomalies
3-4x perinatal mortality & morbidity despite current 90% C.S. rate for persistent breech:
- congenital anomalies (2-3x risk)
- birth trauma mainly due to head entrapment in partially dilated Cx
fetal position denoted by position of sacrum in relation to maternal abdomen

frank breech: hips & knees extended (0.5% cord prolapse rate)
complete breech: hips & knees flexed (4-6% cord prolapse rate)
footling breech: one hip partly extended & knees flexed (15-18% cord prolapse rate)

as long as the baby is coming out with their stomach facing the mother's buttock, the baby should deliver itself - DO NOT TOUCH the baby until head is delivered OR there is delay to delivery of the head of more than 6 minutes from the time buttocks is visible or more than 4 minutes from time umbilicus is visible
- touching the baby prematurely may stimulate respirations causing meconium aspiration
- putting traction on the baby during delivery can cause the fetal head to extend, getting it trapped during delivery

breeches are generally delivered easiest with mother on all fours however if mother prefers other positions then allow that

avoid premature outward traction on fetal feet or lower body until infant has delivered to level of umbilicus
the fetal head must be in flexed position for delivery and premature traction may put it into extension

flexing the fetal knees to enable delivery of the legs
Lovsett’s manoeuvre to rotate the body and deliver the shoulders
- use finger to deliver right arm
- rotate fetus 180deg & repeat to deliver left arm
Mauriceau-Smellie-Veit (MSV) manoeuvre to deliver the head by flexion
- rotate to sacrum anterior & flex head by 2 fingers applied to maxilla via hand underneath fetus, keeping body parallel to floor, whilst 2 fingers of other hand hook along nape of neck