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Flashcards in Breech Deck (15)
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1
Q

What is the definition of breech?

A

When fetus lies longitudinally with bum in the lower pole of uterus.

2
Q

Name the 4 variations of breech and their prevalence and risks if they have any

A

Complete or Flexed (10-15% of breech, risk of PROM/Cord Prolapse)

Extended or Frank (45-50% of breeches, HIGH risk of Cord Prolapse)

Footling (More common in Preterm)

3
Q

Name the 9 different causes/predisposing factors

A
  • Prematurity
  • Multiple pregnancy
  • Abnormal liquor volume
  • Firm abdominal muscles
  • Contracted pelvis
  • Uterine abnormalities
  • Placenta Praevia, pelvic tumours, fibroids
  • Grand multiparity
4
Q

How would you diagnose a Breech presentation antenatally?

A
Palpation
•Auscultation
•If >36/40  USS to confirm
•ECV to be considered
•Place and mode of delivery to be discusse
5
Q

How would you diagnose a Breech presentation postnatally?

A

VE

oBreech feels soft and irregular

oNo sutures

oAnus may be felt – meconium

oExternal genitalia may be felt
oFoot may be felt

6
Q

What can contribute to a successful ECV?

A
  • Multiparity
  • Frank breech
  • Normal or increased amniotic fluid
  • Relaxed uterus
  • Suitable gestational age
7
Q

What is ECV and what does it stand for?

A

ECV is the manipulation of the fetus through the maternal abdomen, to a cephalic presentation, it stands for Eternal Cephalic Version

8
Q

Name the 13 contradictions of ECV

A
  • Limited evidence
  • Placental abruption
  • Severe pre-eclampsia
  • Abnormal dopplers or CTG
  • Absolute reasons for LSCS
  • Placenta Praevia
  • Multiple pregnancies
  • Rhesus isoimmunisation
  • Vaginal bleeding within 7 days
  • SROM
  • Caution in oligohydramnios and hypertension
  • History of LSCS controversial
  • IUD
9
Q

Name the 5 different complications of ECV

A
  • Fetal distress
  • Placental abruption
  • Fetomaternal haemorrhage
  • ?? Cord entanglement
  • Amniotic fluid embolism
10
Q

Name the 10 steps of the ECV procedure

A
  • Empty bladder
  • CTG
  • Lie flat (Trendelenburg position)
  • ? Tocolysis
  • USS (intermittently throughout)
  • Obstetrician disimpacts the breech
  • By applying pressure to both poles the breech is rotated into a cephalic presentation (following its nose)
  • CTG post procedure
  • Observe for fetal distress, ROM, contractions, bleeding
  • Kleihauer and Anti-D if Rh-ve
11
Q

What is the role of the midwife during the 1st stage of labour in a breech delivery?

A
  • Basically same as cephalic presentation
  • Membranes may rupture early
  • Meconium stained liquor may be present secondary to compression of abdomen
12
Q

What is the role of the midwife during the 2nd stage of labour in a breech delivery?

A
  • Confirm full dilation
  • Consider position
  • Availability of obstetrician, paediatrician, anaesthetist, theatre team (SOAPS)
  • Be prepared – equipment available (obstetric forceps, warm towels, lithotomy poles, resuscitaire, discuss birth with mother
13
Q

Name the 6 breech positions

A
  • LSA Left sacroanterior
  • RSA Right sacroanterior
  • LSLLeft sacrolateral
  • RSL Right sacrolateral
  • LSP Left sacroposterior
  • RSP Right sacroposterior
14
Q

What are the steps of a vaginal breech delivery?

A

Anterior bum gits pelvic floor

Birth of bum

Posterior bum delivered

Legs delivered

Lovsets Manoruvre (to remove arms)

Internal rotation of shoulders

Delivery of posterior shoulder

15
Q

Name the 5 complications of Vaginal breech delivery

A
  • Emergency LSCS
  • Fetal Hypoxia–Cord prolapse; cord compression; premature separation of the placenta
  • Impacted Breech–In obstructed labour
  • Cord Prolapse–More common in flexed or footling breech as have ill-fitting presenting part
  • Premature Separation of Placenta–Retraction of the uterus causes separation
  • Maternal Trauma