7. Types of breech
Frank breech : flexed at hips and
extended at knees
Complete breech : flexed at hips and
flexed at knees
Incomplete breech : one or both hips
are not flex and one or both feet or knees
lie below the breech
11. Abdominal examination
1st Leopold maneuver: ballottement
2nd Leopold maneuver: large part
3rd Leopold maneuver: movable
4th Leopold maneuver: prominence
12. Vaginal Examination
Palpable : both ischial tuberosities,the
sacrum and the anus
DDx : Face presentation (Mouth and
Malar eminence)
Position & Variety : Sacrum&Spinus
process
27. Vaginal delivery
Hyperextension
5 % in term breech presentation
Result : Injury to C spinal cord
Marked hyperextension : C/S
28. Vaginal delivery
Labor induction & Augmentation
No significant mortality and Apgar
between infant with induced vs spontanous]
Oxytocin
Amniotomy
CT confirm adequate pelvis
33. Vaginal delivery
The anterior hip
has now
delivered and
external rotation
has occurred. The
fetal thighs
remain in flexion
with extension
knees.
34. Mode of
delivery
Delivery of the
legs by placing
the fingers
parallel with
medial aspect of
the femur and
displacing
laterally and away
from midline
47. Total breech extraction
The hand is introduced through the vagina
&both feet of the fetus are grasped
Gentle traction the feet through the vulva
Breech appears at the vulva, gentle
traction until the hips are delivered
assisted breech delivery
51. Cesarean section
Recommendation
Large fetus
Contraction or unfavorable shape of pelvis
Hyperextended head
Delivery is indicated but not in labor
Uterine dysfunction
Incomplete or footling presentation
52. Cesarean section
Recommendation
Healthy preterm
Severe fetal growth restriction
Previous perinatal death or newborn
complication of birth trauma
A request for sterilization
Lack of an experienced operator
53. Morbidity & Mortality
Maternal Injuries
Risk : Operative intervention
Manipulations : Risk infection
Intrauterine maneuvers : Rupture of the
uterus +/- lacerations of Cx
Extensions of the episiotomy
Uterine atony , Postpartum hemorrhage
54. Morbidity & Mortality
Perinatal 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
