What is the Bracht Maneuver?
The
Bracht Maneuver is a technique used in obstetrics, specifically for the delivery of the fetal head during a breech birth. It is named after the German obstetrician Erich Bracht who first described it in 1938. The maneuver is designed to aid in the safe delivery of a baby that is in a breech presentation, which is when the baby is positioned to deliver buttocks or feet first instead of the head.
When is the Bracht Maneuver Used?
The Bracht Maneuver is typically employed when spontaneous delivery of the fetal head does not occur after the body has been delivered. It is primarily used when the fetus is in a frank breech position, where the thighs are flexed at the hips and the legs are extended at the knees. This technique is one of several maneuvers available to obstetricians to manage a breech birth, each selected based on the specific circumstances of the delivery.
How is the Bracht Maneuver Performed?
To perform the Bracht Maneuver, the obstetrician supports the newborn's body with one hand while the other hand is placed on the lower back. The obstetrician gently lifts the body upwards towards the mother's abdomen in a smooth, continuous motion. This action encourages flexion of the fetal head, facilitating its passage through the birth canal. It's important to maintain gentle and steady traction, avoiding excessive force which could cause trauma to the baby or mother.
What are the Benefits of the Bracht Maneuver?
One of the main benefits of the Bracht Maneuver is that it is a relatively simple and non-invasive technique, minimizing the risk of injury to the mother and the baby. It promotes a natural flexion of the fetal head, which can help reduce complications associated with breech births. Additionally, it often requires less intervention compared to other maneuvers, making it a preferred choice in many cases.
Are There Any Risks Associated with the Bracht Maneuver?
While the Bracht Maneuver is generally safe, there are potential risks associated with its use. If not performed correctly, there is a risk of cervical spine injury to the baby. Additionally, if excessive force is used, it can lead to
brachial plexus injuries or other trauma. It is crucial that the maneuver is performed by skilled healthcare professionals to minimize these risks.
What are the Alternatives to the Bracht Maneuver?
In cases where the Bracht Maneuver is not suitable, other techniques may be employed. These include the
Mauriceau-Smellie-Veit maneuver, which involves manual assistance of the fetal head, and the
Lövset maneuver, which is used to deliver the arms in a breech birth. Another alternative is the
forceps delivery, though it is less commonly used due to the potential for increased risk of injury.
When Should the Bracht Maneuver be Avoided?
The Bracht Maneuver should be avoided if there are contraindications to vaginal delivery, such as placenta previa or active genital herpes. It may also not be appropriate if the fetus is in a footling breech position, where one or both feet are positioned to deliver first. In such cases, a
Cesarean section may be the safer option for delivery.
Conclusion
The Bracht Maneuver is a valuable technique in the management of breech births, providing a safe and effective way to deliver the fetal head when spontaneous delivery does not occur. While it is generally safe, it requires skill and experience to perform correctly. As with any medical procedure, the risks and benefits must be carefully weighed, and alternative options considered based on the specific circumstances of each delivery. Proper training and practice in this maneuver are essential for obstetricians to ensure the best outcomes for both the mother and the baby.
