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Breech presentation1
This document discusses breech presentation in pregnancy. It defines breech presentation and notes that the incidence is around 3-4% at term, though higher for preterm births. Risk factors for breech presentation include primigravidity, uterine anomalies, fetal anomalies, preterm labor, and multiple pregnancy. Diagnosis methods include clinical examination, ultrasound, CT/MRI, and X-ray. The document outlines methods of breech delivery including spontaneous vaginal delivery, assisted breech delivery, and breech extraction. It describes maneuvers like Lovset's maneuver and notes complications for both the mother and fetus from breech delivery. External cephalic version is discussed as an option to attempt turning the breech baby, along
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Breech presentation1
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- 2. • Definition • Lie •Presentation • Incidence 20%. -28 week 5% -34 week 3-4% by term
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- 4. Etiology of breech presentation •Preterm • Preventing spontaneous version – Frank breech,twins,oligohydramnion,uterine malformation,short cord • Favouring breech– Hydrocephalus,placenta previa,contracted pelvis,cornufundal attachemet of placeta
- 5. 3-4% of fetuspresent by breech at term 7% at 32 weeks 25% at 28 weeks 20% diagnosed initially in labour Incidence
- 6. Causes / Risk Factors Primigravida Uterine anomalies Uterinefibroids Pelvic anatomy Fetal anomalies Multiple pregnancy Preterm labour Oligohydraminos / polyhydramnios Grand multiparity Fetal death
- 10. • Uncomplicated breech •Complicated breech • Complication of breech delivery
- 12. Diagnosis • Clinical examination •Ultrasonogram • CT/MRI • X-ray
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- 14. Methods of breechdelivery Spontaneous Assisted breech delivery Breech extraction
- 15. Breech Delivery The cervixshould be fully dilated and the fetal anus visible on the perineum for active second stage.
- 16. Breech Delivery The womanshould be in lithotomy position.
- 17. Breech Delivery Delivery ofthe breech should be ‘hands off’ Legs and abdomen are born spontaneously.
- 18. Breech Delivery Ensure thatthe fetal back rotates uppermost by carefully grasping the fetal pelvis with fingers & thumbs
- 19. Breech Delivery The fetusshould be allowed to hang once the legs and abdomen have emerged until the wings of the scapula are seen.
- 20. Lovset’s Manoeuvre Grasp thefetus around the bony pelvis with the thumbs across the sacrum. The fetal back should then be turned through 180 degrees until the posterior arm comes to lie anteriorly…….
- 21. Lovset’s Manoeuvre The elbowwill appear below the symphysis pubis and the arm is delivered by sweeping it across the fetal body. The manoeuvre is repeated in reverse to deliver the other arm.
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- 23. Breech Delivery Allow thefetus to hang from the vulva until the nape of the neck is visible. Then carry out Mauriceau-Smellie- Veit manoeuvre
- 24. Delivery of aftercoming head
- 25. Complications of breech delivery Maternal Operativedelivery Birth Injury
- 26. Fetal complications Perinatal mortality Intracranial haemorrhage Vaultfracture Birth asphyxia Birth injuries • Sternomastoid hematoma • Fracture of femur,humourus,clavicle. • Visceral injuries • Nerve injuries
- 27. External cephalic version •37 week • Benefits of ECV • Dangers of version • Anti - D
- 28. External Cephalic Version Bestevidence states that E C V should be offered late in pregnancy Success rate increased with: multiparity adequate liquor station of breech above the pelvic brim
- 29. Technique NST TOCOLYTICS LEFT LATERAL POSITION TRENDLENBURGEPOSITION FORWARD FLIP BACKWARD FLIP INTERMITENT ASCULATATION
- 31. Contraindications of ECV Any contraindicationsof vaginal delivery Scared uterus In labour Rh -ve Oligohydramnion
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