Abnormal Lie and Breech Presentation

Question 1

What are the causes of a non-parallel lie?

Answer 1

1. Idiopathic
2. Prematurity - normal in early pregnancy
3. Polyhydramnios - more room to move
4. Oligohydramnios - less room to move if breech
5. Twin pregnancies - prevents turning
6. Congenital abnormalities
7. Placenta praevia/pelvic tumours/fibroids - restricts engagement

Question 2

What are the two type of breech presentation and which is most common?

Answer 2

1. Extended breech (commonest) - hip flexed, knee extended

2. Flexed breech - hip and knee flexion

Question 3

What scan will confirm a diagnosis of breech presentation?

Answer 3

USS

Question 4

What should you do in breech presentation <37/40 if woman is not in labour?

Answer 4

No action

Question 5

What should you do in breech presentation >37/40?

Answer 5

1. USS to exclude contraindications
2. External cephalic version
3. If unsuccessful, planned C-section at 39/40 (preferred) or vaginal breech birth.

Question 6

What are the contraindications to external cephalic version?

Answer 6

Praevia, multiple pregnancies, IUGR, macrosomia, oligo/polyhydramnios, engaged head, abnormal CTG, PET, ruptured membranes, foetal abnormalities, antepartum haemorrhage in last 7 days, history of C-section.

Question 7

What are the risks involved in external cephalic version?

Answer 7

Cord compression, placental abruption, precipitating labour.