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Breech presentation [autosaved]
This document discusses breech presentation during pregnancy and delivery. It describes the causes of breech presentation as maternal factors like polyhydramnios or fetal factors like anomalies. It also outlines the diagnosis, management during pregnancy including external cephalic version, and delivery methods for breech presentation like vaginal delivery or cesarean section. Complications are discussed for both the mother and fetus.
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Breech presentation [autosaved]
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- 5. Maternal factors • Polyhydramnios •Oligohydramnios • Uterine anomalies (bicornuate, septate) • Space occupying lesions (e.g fibroids) • Placental abnormalities (praevia) • Multiparity (in particular grand multiparas) • Contracted pelvis
- 6. Fetal factors • Prematurity •Fetal anomalies (e.g hydrocephalus, anencephaly) • Multiple pregnancy • Fetal death • Short umbilical cord • Extended legs; because they splint the trunk, and so interfere with spontaneous cephalic version
- 7. Mechanism of delivery •Engagement • Descent • Internal rotation • Lateral flexion • External rotation • Birth : breech then body then head
- 8. Diagnosis of Breech •Clinical • Hx exaggerated subcoastal discomfort or lump under the ribs • Fetal mvts felt predominantly in lower part of uterus • Examination • Ballotable round head at fundus and soft presenting part at lower uterine pole • Fetal heart sounds above umblicus • Meconium seen in labour • Ultrasound • Xray
- 9. Clinical Diagnosis • Abdominalexamination Palpation 1. Fundal grips; the head is felt with its characters 2. Pelvic grip; the breech is felt, with its characters. 3. Auscultation The fetal heart sounds are heard just at, or above the level of the umbilicus
- 10. Vaginal examination • 1.Slow dilatation of cervix, sausage-chapel bag of fore-waters, and liability to premature rupture of the membrane and prolapse of the cord. • 2. After rupture of the membranes, the presenting part is felt, that is , the two buttocks with the anus in between , the genitalia on one side and the sacral spines on the opposite side. • 3. In case of complete breech, the feet are felt on the same level as the buttocks. • 4. In case of breech with extended legs, the buttocks only are felt. In case of footling presentation, the feet are at a lower level than the buttocks. In case of knee presentation, the knees are a lower level than the buttocks.
- 11. BREECH PRESENTATION Management duringpregnancy After 36 weeks Spontaneous version External cephalic version
- 12. Version • External cephalicversion • Internal podalic version
- 13. External Cephalic Version Indelivery room NPO and ready for c/s CTG & USS Tocolytic Head down position Dislodge breech then gently turn around US and CTG after procedure.
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- 15. Risks of ExternalCephalic Version • Placental abruption • Premature rupture of the membranes • Cord accident • Transplacental haemorrhage(remember anti-D administration in Rhesus-negative women) • Fetal bradycardia
- 16. Contraindications of ExternalCephalic Version • Previous scar on the uterus • Placenta praevia • Unexplained APH • Pre-eclampsia • Multiple pregnancy • Rhesus isoimmunisation • Elderly primigravida • IUGR • Oligohydramnios • Polyhydramnios
- 17. Caesarean section Vaginal delivery •Spontaneous breech delivery • Assisted breech delivery • Total breech extraction
- 18. Indications of vaginaldelivery a) Frank or complete breech presentation b) Gestational age > 36 weeks c) Estimated foetal weight 2.5-3.5 kg d) Foetal head must be flexed e) Adequate maternal pelvis f) No other obstetric complications.
- 19. Management during labour •During labour: If there is contracted pelvic, and fetus is living and good; do caesarean section. Rest in bed and avoid repeated vaginal examination to prevent PROM PV is done after ROM to exclude cord prolapse.
- 20. • Pinard manoeuvreto deliver extended knees
- 21. • Second stage:Delivery of the aftercoming head • Burns Marshall method • Mauriceau-Smellie-veit maneuver • Wigand Martin method • Prague maneuver • Piper forceps
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- 24. Prague maneuver The backof the fetus fail to rotate to the anterior
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- 26. Total breech extraction Indication •1. Prolonged second stage of labor • 2. Twins • 3. Maternal disease • 4. Prolapsed cord • 5. Fetal distress
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- 28. Cesarean section • Indications: •Large fetus • Contraction or unfavorable shape of pelvis • Hyperextended head(Star gazing) • Uterine dysfunction • Incomplete or footling presentation • Primigravida
- 29. Indications of Csin Breech • Healthy preterm • Severe fetal growth restriction • Previous perinatal death or newborn • complication of birth trauma • Lack of an experienced operator
- 30. Complications of BreechDelivery • Maternal complications Risk of Operative intervention Risk of infection due to Manipulations Intrauterine maneuvers : Rupture of the uterus +/- lacerations of Cx • Extensions of the episiotomy • Uterine atony • Postpartum hemorrhage
- 31. Complications cont. • Fetalcomplications 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
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