Your SlideShare is downloading. ×
  • Like
20
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×

Now you can save presentations on your phone or tablet

Available for both IPhone and Android

Text the download link to your phone

Standard text messaging rates apply

20

  • 2,384 views
Published

 

Published in Health & Medicine
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to comment
No Downloads

Views

Total Views
2,384
On SlideShare
0
From Embeds
0
Number of Embeds
1

Actions

Shares
Downloads
282
Comments
0
Likes
5

Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide

Transcript

  • 1. BREECH PRESENTATION & DELIVERY Panwad Rattanasrithong INT2
  • 2. Definition & Clinical importance
  • 3. DefinitionThe presentation that the fetus is inlongitudinal lie and its buttock enter thepelvis first
  • 4. Incidence3-4% of singleton deliveries15% at 29 – 32 weeks
  • 5. ETIOLOGYPrecipitating factor Gestational age Great parity / Multiple fetuses (uterine relaxation) Hydramnios / Oligohydramnios Hydrocephalus / Anencephalus Previous breech delivery Uterine anomalies / Pelvic tumors Placenta previa
  • 6. Types of breech
  • 7. Types of breechFrank breech : flexed at hips andextended at kneesComplete breech : flexed at hips andflexed at kneesIncomplete breech : one or both hipsare not flex and one or both feet or kneeslie below the breech
  • 8. Diagnosis
  • 9. Abdominal examination1st Leopold maneuver: ballottement2nd Leopold maneuver: large part3rd Leopold maneuver: movable4th Leopold maneuver: prominence
  • 10. Vaginal ExaminationPalpable : both ischial tuberosities,thesacrum and the anusDDx : Face presentation (Mouth andMalar eminence)Position & Variety : Sacrum&Spinusprocess
  • 11. Imaging Techniques Ultrasound CT MRI
  • 12. Mechanism of delivery
  • 13. Mechanism of deliveryDenominator
  • 14. Mechanism of deliveryEngagementDescentInternal rotationLateral flexionExternal rotationBirth : breech body head
  • 15. Mechanism of deliveryEngagement Descent
  • 16. Mechanism of deliveryInternal rotation Lateral flexion
  • 17. Mechanism of deliveryExternal rotation Birth : breech
  • 18. Mechanism of delivery Birth : body head
  • 19. Modes of delivery
  • 20. Modes of deliveryCesarean sectionVaginal delivery Spontaneous breech delivery Assisted breech delivery (Partial extraction) Total breech extraction
  • 21. Vaginal delivery
  • 22. Vaginal delivery Entrapment of fetal head : Duhrssenincision Entrapment of fetal arm behind the neck(nuchal arm) Prolapse cord : complete – 5% ,footling-15%
  • 23. Duhrssen incision
  • 24. Vaginal deliveryUnfavorable pelvis Gynecoid & anthropoid : favorable Platypelloid & Android : unfavorable
  • 25. Vaginal deliveryHyperextension 5 % in term breech presentation Result : Injury to C spinal cord Marked hyperextension : C/S
  • 26. Vaginal deliveryLabor induction & Augmentation No significant mortality and Apgarbetween infant with induced vs spontanous] Oxytocin Amniotomy CT confirm adequate pelvis
  • 27. Vaginal deliveryManagement of labor Establish : Membranes,labor,Fetalcondition,UC Notified nursery Stage of Labor : Cx , Eff , Station ,Presentation Fetal Monitoring : FHR q 15 min (most continue EFM) PV check cord prolapse & FHR q 5-10min (MR)
  • 28. Vaginal deliveryMethods of Vaginal delivery Spontaneous breech delivery Partial breech extraction Total breech extraction
  • 29. Vaginal deliveryAssisted Breech Delivery
  • 30. Vaginal deliveryThe posterior hip of frankbreech is delivering
  • 31. Vaginal delivery The anterior hip has now delivered and external rotation has occurred. The fetal thighs remain in flexion with extension knees.
  • 32. Mode of deliveryDelivery of thelegs by placingthe fingersparallel withmedial aspect ofthe femur anddisplacinglaterally and awayfrom midline
  • 33. Mode of deliveryDelivery of the body.
  • 34. Delivery of the shoulder Cats paw method Classical method Lovset ‘s method
  • 35. Cats paw method
  • 36. Cats paw method
  • 37. Classical Method
  • 38. Lovset’s Method
  • 39. Partial breech extraction or breech assistingDelivery of the aftercoming head Mauriceau-Smellie-veit maneuver Prague maneuver Piper forceps
  • 40. Mauriceau-Smellie-Veit Maneuver
  • 41. Prague maneuver The back of the fetus fail to rotate to the anterior
  • 42. Piper Forceps
  • 43. Total breech extractionIndication 1. Prolong second stage of labor 2. Twin 3. Maternal disease 4. Prolapse cord 5. Fetal distress
  • 44. Total breech extractionContraindication 1. Cervix not fully dilated 2. CPD
  • 45. Total breech extractionThe hand is introduced through the vagina&both feet of the fetus are graspedGentle traction the feet through the vulvaBreech appears at the vulva, gentletraction until the hips are deliveredassisted breech delivery
  • 46. Completebreechextractionbegins withtraction on thefeet and ankles.
  • 47. continues withtraction on thethighs
  • 48. the scapulasbecomesvisible and thebody rotates,usually to theside of themother
  • 49. Cesarean sectionRecommendation Large fetus Contraction or unfavorable shape of pelvis Hyperextended head Delivery is indicated but not in labor Uterine dysfunction Incomplete or footling presentation
  • 50. Cesarean sectionRecommendation Healthy preterm Severe fetal growth restriction Previous perinatal death or newborn complication of birth trauma A request for sterilization Lack of an experienced operator
  • 51. Morbidity & MortalityMaternal Injuries Risk : Operative intervention Manipulations : Risk infection Intrauterine maneuvers : Rupture of theuterus +/- lacerations of Cx Extensions of the episiotomy Uterine atony , Postpartum hemorrhage
  • 52. Morbidity & MortalityPerinatal Morbidity & Mortality Preterm delivery & low birth weight & IUGR Prolapse cord Birth aphyxia Fetal Injuries Fx of humerous and clavicle Fx of femur Hematomas of sternocleidomastoid Separation of epiphyses of scapular,humerus or femur Brachial plexus Avulsion of upper C-spine Skull Fx , intracerebral injury
  • 53. Intracerebral haemorrhage
  • 54. Birth asphyxia
  • 55. Version
  • 56. VersionExternal cephalic versionInternal podalic version
  • 57. External Cephalic Version
  • 58. Thank you for attention