2017 Breech Flashcards
What information should be given to women with breech presentation at term?
- Offer ECV unless absolute contraindication
- Advise on risks & benefits of ECV & implications for mode of birth
- If unsuccessful or decline, risks & benefits of planned vaginal breech vs CS
Why does planned CS for breech have a slightly reduced perinatal mortality compared to vaginal breech birth?
- Avoid stillbirth after 39/40
- Avoid intrapartum risks
- Risks of vaginal breech birth
What are the risks of perinatal mortality for a breech birth?
- 0.5 / 1000 CS after 39/40
- 2 / 1000 planned vaginal breech
- 1 / 1000 planned cephalic birth
What are the risks of vaginal birth for perinatal morbidity
- Low APGAR scores
- Serious short-term complications
- No increase in long-term morbidity
How often is emergency CS needed in planned vaginal breech birth?
40%
What are the higher risk factors in planned vaginal breech birth?
- Hyperextended neck on USS
- High EFW > 3.8 kg
- Low EFW < 10th centile
- Footling presentation
- Evidence of antenatal compromise
How should vaginal breech births be managed?
- Skilled personnel
- IOL not recommended
- Augmentation only if contraction frequency is low with epidural
- Continuous fetal monitoring
- Hospital with CS facilities
- Active 2nd stage only if adequate descent in passive 2nd stage
- Semirecumbant or all-fours position
- Assistance without traction +/- manoeuvres if delay or compromise
How should preterm breech babies be delivered?
- Individualise based on stage, type of breech, fetal well-being, skill base
- CS not routinely recommended 22-26/40
- Planned CS recommended if planning delivery due to maternal or fetal compromise
What action can be taken for head entrapment with breech birth?
- Incision in cervix for vaginal birth
- Vertical uterine incision extension for CS
- +/- tocolysis
How should twin pregnancies with breech presentation be managed?
- First twin breech: planned CS
- But if spontaneous labour, individualise plan
- Second twin breech: no change in plan
What is the incidence of breech presentation at term?
3-4%
What are the risk factors for breech presentation?
- Preterm
- Uterine anomalies
- Congenital anomalies
- Previous breech presentation
- Nulliparity
What proportion of breech presentations at term are not diagnosed until women present in labour?
25%
How long should be allowed for the passive second stage in vaginal breech birth?
- 2 hours
- If breech not visible following this, advise CS
During the active second stage of vaginal breech birth, when should intervention occur?
- > 5 mins from delivery of buttocks to head
- > 3 mins from umbilicus to head
