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Flashcards in Breech Deck (46)
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1

What is the definition of breech?

The fetus lies longitudinally with the buttocks in the lower pole of the uterus

2

What is the bitrochanteric diamter?

femur to femur across - 10cm

3

What 2 diameters are both 10cm?

head and bitrochanteric

4

What is the incidence of breech births?

3-4% at term
20% at 28 weeks

5

What are the variations of Breech?

Complete/flexed
extended/frank
knee
footling

6

What is complete/flexed breech?

both feet crossed middle
10-15%
risk of PROM and Cord prolapse as feet and buttocks both on cervix

7

What is extended/frank breech?

45-50% of breeches
feet up by head

8

What is knee breech?

knee in the birth canal
35-45%
high risk of cord prolapse

9

what is footling breech?

foot lower than body
more common in preterm

10

what are the causes of breech babies? 10

prematurity
multiple pregnancy
abnormal liqour volume
firm abdo muscles
conracted pelvis
hydrocephaly
uterine abnormalities
placenta praevia, pelvic tumours, fibroids
grand multiparity

11

How do we diagnose breech antenatally? 3

palpation
auscultation
if >36/40

12

How do we diagnose breech in labour?

VE -
breech feels soft and irregular
no sutures
anus may be felt
thick together meconium
external genitalia might be felt
foot might be felt

13

What are the managements of breech antenatally ?

maternal position
-knee to chest 15 mins every 2 hours for 5 days
moxibustion (acupuncture)
-33-35/40 may consider - must be trained

14

What does ecv stand for?

external cephallic version

15

Define ECV

manipulation of the fetus through the maternal abdomen, to a cephalic presentation

16

at what gestation is ecv done?

36 for primips
37 for multips

17

what is the success rate of ecv?

50%- +chance for multips
decreases chance of cs

18

What risks are there after ecv?

higher chance of fetal distress
obstructed labour
instrumental - may be op
fetomaternal haemorrage
cord entanglement
amniotic fluid embolism

19

What makes ecv successful? 5

multiparity
frank breech - easier to hold bottom
normal or + amniotic fluid
relaxed uterus
suitable gestational age

20

What are the contraindications of ECV? 12

abnormal dopplers or ctg
absolute reasons for cs
placenta praevia
multiple pregnancies
rhesus isoimmunisation
pv bleed within 7 days
SROM
caution for oligo and hypertension
history of cs
IUD
placental abruption
severe pre-eclampsia

21

What position must the mother be in for ecv?

trendelenburg

22

What is the process of ecv? 10

empty bladder
ctg
lie in trendelenburg
? tocolysis - terbutaline, salbutamol
USS throughout
Obs dr disimpacts the breech
Apply pressure to both poled rotates into cephalic following its nose
CTG after
Observe for distress, contractions, bleeding,
kleihauer and anti d if rh neg

23

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

24

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

25

Indications for LSCS
4

- hyperextension of the neck on USS (face up)
-EFW >3.8kg or <10th centile
-footling
-antenatal fetal compromise

26

What can you do for an unplanned vaginal breech birth?

depends on:
-stage of labour
-risk factors
-clinical expertise

27

When should you not offer a cs?

second stage of labour

28

What are important to assess in vaginal breech birth?

position
neck + legs
EFW

29

Can you IOL breech?

No - augmentation can be considered though 2nd to epidural

30

Care in stages of labour?

1st- same labour care as cephalic
-membranes can rupture early

2nd- passive until breech visible - max 2 hours then lscs
-confirm full dilatation -consider position
-be prepared - equipment and staff