prenatal development

1. {WHAT IS IT; HOW IS IT DETECTED; WHAT ARE THE
CAUSES; HOW TO DEAL WITH THE COMPLICATION;
DANGERS TO THE FOETUS AND MOTHER}

2.  Birth complications are any abnormal obstetrical conditions occurring during
pregnancy, labour or delivery and can adversely affect the baby or mother’s life.
 Some birth complications can be mild whereas others can be dangerous and life
threatening.
 Examples of birth complications include:
Uterine rupture
Shoulder dystocia
Umbilical cord prolapse
Foetal breech

3.  A baby is in breech when they are positioned feet or bottom first in the uterus.
 Ideally a baby is positioned so that the head is delivered first during a vaginal
birth
 Most breech babies will turn to a head-first position(vertex presentation) by the
36th week of pregnancy.

4.  Frank Breech: the baby’s buttocks are aimed at the vaginal canal with it’s legs
sticking straight up in front of their body and feet near the head.
 Complete Breech: the baby’s buttocks are pointing downward and both hips and
knees are flexed( folded under themselves).
 Footling Breech: one or both of the baby’s feet point downward and will deliver
before the rest of their body.
 Transverse Lie: this is a form of breech presentation where the baby is positioned
horizontally across the uterus instead of vertically. This would make the shoulder
enter the vagina first.

6.  It s not always known why a foetus is in breech. Some factors that may contribute to a foetus
being in a breech presentation include:
o Multiple gestation- the pregnant woman would be expecting twins or more and this makes it
difficult for each baby to get into the correct position.
o Volume of amniotic fluid- there might be too much/little amniotic fluid. Not enough amniotic
fluid makes it difficult for the baby to swim around while too much amniotic fluid means the
baby has too much space and can flip between breech and head down position.
o The uterus would be small in shape or would have abnormal growths such as fibroids( fibroids
are growths that form in the muscle of the uterus).
o The placenta covers all or part of the opening of the uterus (placenta previa)
o The foetus is preterm- less than 37 weeks of pregnancy- and has not yet turned naturally to the
vertex presentation.
o A history of breech presentation in a previous pregnancy increases the risk of breech
presentation to 9% in the subsequent pregnancy; two consecutive pregnancies with breech
presentation increases the risk to 25%, and 3 consecutive pregnancies with breech presentation
may increase the risk up to 40%.

7.  A breech baby does not cause more or less nausea, vomiting, or other pregnancy
symptoms.
 A baby’s movements will feel a little different in breech position: baby kicks will be
felt lower in the belly, and you may feel your baby’s head as a lump/hard swelling
below the ribs.
 An obstetrician will be able to know that you have a breech baby by placing their
hands at certain places on the abdomen.
 An ultrasound can be used to confirm the baby’s position.
* Almost all babies are breech at some point, but as the pregnancy progresses the
baby will naturally move to a head-down position between the 32nd and 36th week
(after 37 weeks a breech baby is not usually able to turn on its own). *

8.  There is no scientifically proven method that can help prevent a baby from
breeching.
 It is usually after the breech is detected that one can try some recommended
methods to try and turn the baby to the head-first position:
 If a baby is in breech position at 36 weeks, an external cephalic version (ECV) is
offered. This is when a health care professional tries to turn the baby into a head-
down position by applying pressure on the abdomen. It is a safe procedure
although a bit uncomfortable. Around 50% of breech babies can be turned using
ECV, allowing a vaginal birth (……image available on next slide)

10.  Some women may try at-home methods to flip their baby to a head-first position.
These include:
 Bridge position- lie on the floor with legs bent and feet flat on the ground. Raise hips
and pelvis into a bridge position. Hold this position for 10/15 minutes several times a
day.
 Child’s pose- rest in child’s pose for 10/15 minutes. It can help relax pelvic muscles and
uterus. One can also rock back and forth on hands and knees or make circles with the
pelvis to promote activity.
 Music- place headphones or a speaker at the bottom of the uterus to encourage the
baby to turn.
 Temperature- try placing something cold at the top of you stomach where the baby’s
head is. Then place something warm at the bottom of your stomach.
 Webster technique- this chiropractic technique can help the uterus relax. It also helps
to realign the pelvis and ligaments that support the uterus so the baby has sufficient
space to turn to the normal vertex presentation.

11.  The risks of external cephalic version (ECV) include:
i. Premature labour
ii. Premature rupture of the amniotic sac
iii. Blood loss for either the mother or the baby
iv. Emergency c-section (caesarean birth)
v. The baby might turn back to the breech position
 Although the risk of these complications is small, some health care providers
prefer not to try to flip a breach baby.

12.  Flipping a baby may not be safe if the mother has any of the following issues:
Bleeding from the vagina
Placenta previa(placenta covers all or part of cervix)
An abnormally small baby
Low level of amniotic fluid
Low or high foetal heart rate
Premature rupture of the membranes
Twins or more

13.  Having a breech baby does not change some of the first signs of labour like
contractions or rupturing of the membranes( this is often referred to as water
breaking).
 If one is in labour and goes to the hospital, the healthcare provider will confirm
the baby’s position a final time.
 If a baby is in breech, doctors usually prefer to perform planned C-sections
(surgical delivery of a baby through a cut -incision- made in the mother’s abdomen
and uterus).
 A vaginal breech birth can be attempted in some cases, but a vaginal delivery can
be complicated and dangerous because of risks of injury.

14.  Most breech babies are born healthy although there is a slightly elevated risk for
birth defects.
 The risks do not usually occur until it is time to deliver.
 For babies- the vaginal birth, especially, can cause injuries to the baby’s arms or
legs such as dislocation or broken bones. There can also be umbilical cord
problems( umbilical cord twisted or flattened during delivery) which can cause
nerve and brain damage due to a lack of oxygen.
 For mothers- a vaginal delivery can be dangerous as it may cause perineal tears( a
woman’s vagina and the surrounding tissue are likely to tear during delivery
process), as well as excessive bleeding which can lead to maternal death( if the
delivery results in tears to the uterus, or if the uterus doesn’t contract to deliver
the placenta heavy bleeding results).

15.  In cases where planned or emergency C-sections are performed, there are also
some risks to the baby and the mother.
 For babies- babies born by scheduled C-section are more likely to develop a
breathing issue that causes them to breathe too fast for a few days after birth
(transient tachypnea); and although rare, accidental nicks to the baby’s skin
during surgery can occur (surgical injury).
 For mothers- there is risk of developing an infection of the lining of the uterus(
endometritis), in the urinary tract or at the site of the incision. There is also risk
of blood loss due to heavy bleeding during and after surgery. Having a C-section
increases the risk of complications in future pregnancies and in other surgeries.

16.  TESLYNE J ASHLEY R216464D(HDP)
 KEISHA D KUDITA R216423Q(HDP)
 MEMORY MACHEKA R215455D(HCDP)
 RUTENDO N MACHIVENYIKA
R215431C(HCDP)
 YOLANDA VERE R215458R(HCDP)
 PROVIDENCE CHITURI R215438B(HCDP)
 BENHILDA T VIRIRI R216444G(HDP)
 EVERJOY MTOMBENI R215419F(HCDP)
 TENDAI T WATSIKA R216424L(HDP)
 MILLICENT MUTSATSA R215432R(HCDP)
 NOMALANGA M SIBANDA R216449U(HDP)
 NOMTHANDAZO P MOYO R216441P(HDP)
 NICOLE M MUSHORE R215417Q(HCDP)
 VONGAI MUNOTENGWA R215439Z(HCDP)
 TARISO MAVESERE R215461L(HCDP)
 NYAHSA MUTONGOREYA R216438P(HDP)
 ESTHER C MADONDO R216435U(HDP)
 IVY ANTONIO R216459D(HDP)

17.  Taner, G., Abdulkadir, T., Ergul, D. & BorMeryem, H. (2020). Comparison of
maternal foetal complications in pregnant women with breech presentation
undergoing spontaneous or induced vaginal delivery, or caesarean delivery.
Taiwanese Journal of Obstetrics and Gynaecology, Vol 59.
https://doi.org/10.1016/j.tjog.2020.03.010
 https://doi.org/10.10.1002/14651858.CD000184.pub3
 https://www.nhs.uk/pregnancy/labour-and-birth/what-happens/if-your-baby-is-
breech
 https://www.mayoclinic.org/tests-procedures/c-section/about/pac-20393655
 https://my.clevelandclinic.org/health/diseases/21848-breech-baby