Definition. Breech extraction is a surgery aiding delivery, using which the fetus is removed from the birth canal with the help of manual maneuvers, if it is in transverse lie or breech presentation.
Types of surgery. There are three types of fetal extraction:
► breech extraction by foot traction;
► breech extraction by two feet traction;
► extraction by groin traction.
3.1. BREECH EXTRACTION BY FOOT TRACTION
The surgery of extraction (removal) of the fetus is carried out only in emergency situations, when immediate delivery is necessary for maternal and/or fetal reasons. Currently, this surgery is performed in case of transverse lie of the second twin after the birth of the first one or in breech presentation.
The previously proposed surgery of podalic version and extraction of the fetus in cephalic presentation is currently abandoned due to the high rate of maternal and fetal injuries. In this situation, it is advisable to perform cesarean section.
Indications:
► acute abruption of placenta;
► acute fetal hypoxia;
► severe preeclampsia or eclampsia;
► persistent secondary uterine inertia or weak bearing down efforts in the second stage of labor;
► poor health state of the parturient woman. Surgery prerequisites:
► complete cervical dilation;
► ruptured membranes;
► proportionality between fetal head and maternal pelvis;
► administration of anesthesia and antispasmodics (risk of uterine os spasm during surgery).
Preparation for surgery: the same as in other vaginal surgeries. Technique of surgery of extraction by foot traction. Surgery of extraction by foot traction includes four stages.
1. Grasping the foot and extracting the fetus up to the umbilical ring.
2. Extracting the fetus up to the inferior scapular angle.