50. Vaginal breech delivery.Manoeuvres Flashcards
what are the vaginal delivery manuevers ?
legs
pinard manuever-
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shoulder
loveseat manuever-
classic manuever (muller the opposite)
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head
forceps
burns marshall manuever
bracht Manuever
modified mariceau -smellie - veit manuever
modified prague manuever
describe pinnard manoeuvre ?
used in frank breech to make it into footling breech
it can done when the membranes have ruptured easily or when the buttocks and the trunk up tot he umbilicus is born
the middle and index finger are carried to the popliteal fossa, it is then pressed and abducted - resulting in spontaneous flexion of the fetal leg
the ankles are then grabbed and brought out
when do we use loveseat and classical manuever for the delivery of the shoulder?
when the arms are extended and not flexed to the body this is due to unecessary traction forgetting he never pull but push from above method
describe the classical methods of the delivery of the shoulder in the extended arm ?
patient needs to be in general anesthesia
first the posterioir arm is delivered
the ankles are grabbed and held to the right hand side with the right hand and slightly pulled upwards
the left hand is introduced along the curve of the eft buttock
the arms is found and with firm pressure on the humerus aspect the baby’s armis brought in front of the baby’s face and it is then brough down
the posterior arm is now fixed to the side of the body
grabbing the arms by near the wrist aspect and the hip
rotate the body so the body is facing the left thigh of the mother and the baby’s body is depressed slightly towards the perineum now
using the exact same technique now with the the right hand deliver the extended anterior arm
the fixing it to the body
and rotate the body to the sacral anterioir position again
why is loveseat manuever used in preference to classical manuever ?
there is no need for general anesthesia
and this single manuever is effective in all types of displacement of the arm
describe loveseat manuever ?
ONLY STARTED when the inferior angle of the of the anterior scapula is visible underneath the pubic arch
the baby is grasped by femeropelvic grip , the thumbs in parallel to the vertebral column
The trunk is rotated 90° maintaining a downward traction. take the index finger place it over the shoulder of the baby hook it over the antecubital fossa and bring it down
baby is rotated 180 degrees in the opposite direction maintaining downward traction again , the other shoulder is now under the symphysis pubis
using the same technique bring the arm down
what is the burns marshall method ?
the baby is allowed to hang by its own weight
suprapubic pressure is applied with the flat of the hand in downward and backward direction
pressure exerted more towards the sinciput - to promote flexion of the head
and when the nape of the head is visible under the pubic arch after 1-2 minutes
the baby is grasped by the ankles with finger in between the two
while applying traction the the trunk is swung by the grabbed ankles in an upward and forward direction meanwhile the other hand guards the perineum
describe forces delivery of the head ?
The head should be brought as low down as possible by allowing the baby to hang by its own weight aided by suprapubic pressure.
When the occiput lies against the back of the symphysis pubis, an assistant wraps the arms and legs and body in a towel the legs are raised , careful not to rase it to much because it can cause extension
feel for the space between the head and the shoulder to correctly lace the blades
introduction of the blades are from below. Pipers forceps (long) are ideal while maintain suprabpubic pressure downwards and backwards
pull with a stead downward traction one finger is in the back of the occiput to keep it flexed
assess the perineum and perform epstiotoy if necessary
do not bring the blades above the horizontal plane because the ends of the blades can cause trauma
or The forceps pull maintains an arc, which follows the axis of the birth canal ???= dutta
what is bracht maneuver?
breech allowed to be delivered till umbilicus
extended legs of frank breech are not brought down
the fetal trunk and extended leg are grasped with both hands
four finger around the lowers back and the thumb in parallel to the posterior femur
there is then upward and backward traction whilst gentle suprapubic pressure downwards and backwards
the baby is held not pressed to the mothers symphysis pubis when the roation is nearly complete
the maintenance of this position and uterine contractions causes
the baby’s head to be birthed spontaneously in full extension
describe the modified Mauriceau-Smellie-Veit technique) ?
The baby is placed on the supinated left forearm (preferred) with the limbs hanging on either sides.
The middle and the index fingers of the left hand are placed over the malar bones on either sides (modification of the original method, where the index finger was introduced inside the mouth).
This maintains flexion of the head.
The ring and little finger of are placed on right , the index finger is placed on the left shoulder hooking it
the middle finger is placed on the suboccipital region
at the height of uterine contraction , Traction is given in downward and head is slightly flexed until the hairline/nape of the neck is visible under the subpubic arch superiorly and chin visible inferiorly
The assistant gives suprapubic pressure during the period to maintain flexion.
Thereafter, the fetus is carried in upward and forward direction toward the mother’s abdomen
when is modified prague manuever employed ?
rarely the back of the fetus do not rotate anteriorly
rotation of the back may be tried b strong rational traction of the bony pelvis and legs
if it fails we use this
describe the prague manoeuvre ?
two fingers of one hand grasping the shoulder of thefts from down below , while the other hand draw the fetus up and over to the maternal abdomen
