The Bracht Maneuver

Vaginal delivery of breech presentation

“…Mechanisms that maximize power from above may be associated with lower risk of trapped after-coming fetal parts than manoeuvres that involve fetal traction [1,[3][4][5][6]. Maternal cooperation is essential, and heavy sedation or dense epidural analgesia should be avoided to maximize expulsive efforts [52].…”

“…None have been well studied independently. Maximizing maternal pushing is considered safe, and the use of an assistant to apply suprapubic pressure after crowning to maintain flexion of the fetal head and facilitate its engagement may be helpful (Bracht manoeuvre) [1,3].…”

“…Pre-emptive Caesarean section avoids most of this risk. Prior to 1940, despite breech perinatal mortality rates of 5%, CS involved too much maternal risk to be used routinely to lower fetal risk [1]. Improved safety with antibiotics, blood transfusion, and Kerr's lower segment incision prompted consideration of routine CS for breech presentation [2].…”

“…Improved safety with antibiotics, blood transfusion, and Kerr's lower segment incision prompted consideration of routine CS for breech presentation [2]. Concurrently, improvements in vaginal breech delivery technique markedly lowered the risk of a trial of labour in experienced hands, and breech perinatal mortality continued to fall, despite stabilization of the CS rate [1,[3][4][5][6][7][8]. The debate surrounding the optimal mode of delivery for the breech fetus focuses on a single clinical question: what is the magnitude of risk to the fetus of a TOL and how should we balance it against the increased immediate and future risk of CS to the mother and her future children?…”

Perinatal Outcome in Breech Presentation Depending on the Mode of Vaginal Delivery

“…In 1953, Plentl and Stone [5] revised the problem of vaginal breech delivery and concluded, supported by statistical analyses of many studies all over the world, that more interventions around a breech fetus and earlier beginning of obstetric interventions result in higher perinatal mortality and morbidity and also higher risk of maternal injury. Explaining why Bracht's maneuver had not been accepted in the AngloSaxon world authors say: 'The art of waiting is severe and few obstetricians have the courage and the patience needed to calmly observe the spontaneous birth of a breech fetus' [5] . Later on, Vermelin and Thiessen [6] introduced techniques of so-called passive breech presentation with spontaneous or supported breech delivery without obstetric intervention.…”