Flashcards in Breech Deck (46)
What is the definition of breech?
The fetus lies longitudinally with the buttocks in the lower pole of the uterus
What is the bitrochanteric diamter?
femur to femur across - 10cm
What 2 diameters are both 10cm?
head and bitrochanteric
What is the incidence of breech births?
3-4% at term
20% at 28 weeks
What are the variations of Breech?
What is complete/flexed breech?
both feet crossed middle
risk of PROM and Cord prolapse as feet and buttocks both on cervix
What is extended/frank breech?
45-50% of breeches
feet up by head
What is knee breech?
knee in the birth canal
high risk of cord prolapse
what is footling breech?
foot lower than body
more common in preterm
what are the causes of breech babies? 10
abnormal liqour volume
firm abdo muscles
placenta praevia, pelvic tumours, fibroids
How do we diagnose breech antenatally? 3
How do we diagnose breech in labour?
breech feels soft and irregular
anus may be felt
thick together meconium
external genitalia might be felt
foot might be felt
What are the managements of breech antenatally ?
-knee to chest 15 mins every 2 hours for 5 days
-33-35/40 may consider - must be trained
What does ecv stand for?
external cephallic version
manipulation of the fetus through the maternal abdomen, to a cephalic presentation
at what gestation is ecv done?
36 for primips
37 for multips
what is the success rate of ecv?
50%- +chance for multips
decreases chance of cs
What risks are there after ecv?
higher chance of fetal distress
instrumental - may be op
amniotic fluid embolism
What makes ecv successful? 5
frank breech - easier to hold bottom
normal or + amniotic fluid
suitable gestational age
What are the contraindications of ECV? 12
abnormal dopplers or ctg
absolute reasons for cs
pv bleed within 7 days
caution for oligo and hypertension
history of cs
What position must the mother be in for ecv?
What is the process of ecv? 10
lie in trendelenburg
? tocolysis - terbutaline, salbutamol
Obs dr disimpacts the breech
Apply pressure to both poled rotates into cephalic following its nose
Observe for distress, contractions, bleeding,
kleihauer and anti d if rh neg
mode of delivery factors - mother
-mat complications least with successful vag breech birth, highest with emergency lscs
-lscs + risk of complications in future pregnancies
-small increased risk of stillbirth in subsequent pregnancies with historic lscs
mode of delivery factors - baby
-planned lscs - small reduction in perinatal morbidity
- decreased risk - avoidance of stillbirth after 39/40, avoidance of intrapartum risks of vaginal breech birth
-risks of perinatal morbidity 0.5:1000 for lscs, 2:1000 for vaginal breech birth
Indications for LSCS
- hyperextension of the neck on USS (face up)
-EFW >3.8kg or <10th centile
-antenatal fetal compromise
What can you do for an unplanned vaginal breech birth?
-stage of labour
When should you not offer a cs?
second stage of labour
What are important to assess in vaginal breech birth?
neck + legs
Can you IOL breech?
No - augmentation can be considered though 2nd to epidural