Breech repositioning unresponsive to Webster technique: coexistence of oligohydramnios

Abstract

Objective: The purpose of this report is to describe the results of a pregnant woman demonstrating breech fetal presentation who was managed with Webster technique in the presence of oligohydramnios.

Clinical features: A 23-year-old primigravida woman sought chiropractic care for the management of breech presentation and bilateral sacroiliac arthralgia at 34 weeks' gestation.

Intervention and outcome: Sacral manipulation and abdominal effleurage (Webster Technique) was used to address breech presentation and sacroiliac arthralgia for a total of 7 treatments over a 3 1/2-week duration. The patient's sacroiliac pain reduced from 8/10 to 3/10. However, breech presentation was unchanged at each treatment. At a scheduled prenatal surveillance during the 37th week of gestation, the midwife detected vaginal bleeding and reduced fundal height, which resulted in hospitalization, diagnosis of oligohydramnios, and an emergency cesarean delivery.

Conclusion: For this particular patient, the breech presentation was not corrected using the Webster technique. Clinicians who use the Webster technique to manage breech fetal presentation should be aware of undiagnosed comorbidities as a complicating factor in clinical presentation. Screening for previously undiagnosed comorbidities, such as oligohydramnios, must be considered.

Keywords: Breech presentation; Chiropractic; Manipulation, spinal; Oligohydramnios.

Fig 1

Locations of lower abdominal effleurage therapy. Effleurage therapy was applied to the areas indicated in red on the contralateral side of sacroiliac dysfunction.

Fig 2

Incidence of fetal malpresentation by gestational age. Fetal malpresentation includes breech, transverse, and oblique fetal presentations. Figure derived by permission of Wiley-Blackwell from Fox and Chapman.