11 - Obs - Abnormal Lie and Breech Presentation - Breech Presentation

Question 1

what is breech?

what are 3 types and % of cases? describe the types?

Answer 1

pres of buttocks

extended 70% - legs extended
flexed 15% legs flexed
footling 15% one/both feet presentating

Question 2

Aetiology: No cause in most. Prev breech in 8%. ? is a common ass. Conditions prev mvmt eg fetal/? abnormalities or ?, or preventing ? eg PP, ?
and deformities, are more common

Answer 2

prematurity
uterine
twins
engagement
tumours

Question 3

Complx

Perinatal and long-term morb and mort are ?. Fetal ? more common, even normal breech babies have higher rates ? ? ? handicap – indep of mode of delivery.

Labour has hazards: Poor ‘?’ of breech/feet -> incr rate ? ?. Head may get ?– not a prob if cephalic as just -> ? ?. May cause rapid ?

Answer 3

increasing
abnorms
long term neuro
fit
cord prolapse
trapped
c/s
death

Question 4

MGMT - ECV
From ?wks, attempt to turn baby to ? presx. ?% success rate
Technique: ECV done w/o ?, improved by uterine relaxant (?) to mother if uterine ? is high or ? attempt failed. Done under ??? guidance and in ? to allow immed ? if compx. ??? done straight after and ? given to Rh?ve women.

Answer 4

37
cephalic
50
anaesthetic
tocolytic
tone
initial
USS
hosp
delivery
CTG
anti-D

Question 5

MGMT - ECV
Safety: V ? risk of fetal damage in expert hands, placental ?/uterine ? have been reported. Immed emergency c sec req in 0.5%.

Factors affecting success: Lower success in ? women, Caucasians, ? breech, head not ?, uterine ? high, ? women, and reduced ?.
Contraindications: Fetal ?, if vaginal deliv contraindicated anyway eg ??, twins, membranes ruptured or if recent ???. One prev ? ? not a contraindication.

Answer 5

low
abruption
rupture

nulliparous
engaged
palpable
tone
obese
liquor

compromise
PP
APH
C/S

Question 6

C/S

If ECV failed/?, or breech presx ?, safest method = c section. Reduces neonatal mort (1%) and ?-? morbidity, no effect on long term outcomes.
Counsel parents but allow them to decide.
Some still wish to deliver vaginally/only found late in labour/2nd ? breech – vaginal deliv still apprt – experience/knowledge required.

Answer 6

contraindicated
missed
short-term
twin

Question 7

Vaginal Breech delivery - pt selection…

-more risk with fetus >?kg, if evidence of fetal ?, if the ? is extended or legs are ?

Answer 7

> 4
compromise
head
footling

Question 8

Vaginal Breech delivery - Intrapartum care - ? not encouraged if ? visible. ???advised. ? analgesia common. In 30% there is ? first stage or poor descent in 2nd. So ? w oxytocin is unwise and ? ? done.

Answer 8

pushing
buttocks
CTG
epidural
slow
augmentation 
C/S

Question 9

Breech delivery technique -
1 - as ? distend the perineum, perform an ?
2 - put a ? behind the ? to deliver the legs
3 - use a finger to hook each ? down
4 - ? delivering the ? once the arms are delivered

Answer 9

buttocks
episiotomy
finger
knee
arm
forceps
head