The breech commonly presents with flexion at the hip and extension at the knees (extended breech) followed by the breech presenting with flexion at the hips and knees (flexed or complete breech). At times one leg could be flexed and the other extended (incomplete breech). Rarely one or both feet may present (footling breech) and at times it maybe knee presentation (Fig. 24.3). Because of the inappropriate fit of the presenting part of the breech to the pelvis, there is a greater chance of cord prolapse and it is higher with footling presentation when it may be as high as 10%. With careful palpation breech presentation is recognized in the antenatal period. Identification becomes easier with increasing gestation and if the mother is mul-tiparous or has a thin abdomen. The fetus would be in the longitudinal lie with the head palpable as a spherical hard mass in the upper pole. The head is usually to one or the other side under the hypochondrium and is tender on deep palpation. The breech which is broader is felt above or within the pelvis. When the breech is extended there is difficulty in identifying the head. It is easier in earlier gestation as the head could be balloted. If the extended breech is in the pelvis it may be difficult to distinguish from a deeply engaged head. An ultrasound examination or vaginal examination will help to identify the head that is engaged. On auscultation with a stethoscope the fetal heart is located above the umbilicus but with a Doptone this may be deceptive as a transducer can pick up the fetal heart rate (FHR) below the umbilicus.
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The first trimester is very important for the mother and the baby. For most women it is common to find out about their pregnancy after they have missed their menstrual cycle. Since, not all women note their menstrual cycle and dates of intercourse, it may cause slight confusion about the exact date of conception. That is why most women find out that they are pregnant only after one month of pregnancy.