Anesthesia for Multiparity, Multiple Gestation, and Breech Presentation

Risk factors associated with a breech presentation include uterine distension (e.g., multiple gestation, polyhydramnios, multiparity), maternal pelvic abnormalities (e.g., pelvic tumors, uterine anomalies), and fetal abnormalities (e.g., anencephaly, hydrocephalus). Fetal head entrapment from breech presentation is more likely to occur before 32-week gestation. The fetal head may be entrapped due to suboptimal cervical dilatation, a relatively large fetal head, or an underdeveloped fetal skull that may not be able to mold to the maternal pelvis. External cephalic version (ECV) is the first-line approach to a full-term pregnancy in breech presentation. Patients with multiple gestation are at a high risk for preterm labor. Preterm labor occurs in women with spontaneous twins at a rate of 22%, while preterm labor in women with twins from in vitro fertilization occurs at a rate of 52%.