Abnormal lie and breech presentation

Question 1

What are the most common causes of an abnormal lie?

Answer 1

More room: polyhydramnios, high parity.

Obstructed turning: fetal / uterine abnormalities, twins.

Obstructed engagement: placenta praevia, pelvic masses, uterine deformity.

Question 2

What are the complications of an abnormal lie?

Answer 2

Failure of head or breech to engage means labout can’t deliver.

Also, a limb or umbilical cord may prolapse, obstructing delivery and eventually causing uterine rupture.

Question 3

How do you manage an abnormal lie?

Answer 3

Before 37wks: do nothing, unless in labour.

After 37wks: Admit, USS to exclude praevia and polyhydramnios. Most stabilise by 41wks, if not, C-S.

If in labour: C-S.

Question 4

How common is breech presentation?

Answer 4

3% of pregnancies at term.

25% of premature.

Question 5

What are the complications of breech presentation?

Answer 5

Long term neurological handicap, independent of mode of delivery.

Fetal abnormalities.

Question 6

How do you manage a breech presentation?

Answer 6

ECV at 37weeks. 50% success rate. Perform with a tocolytic and give anti-D if Rh-ve. 0.5% have emergency C-S after ECV.

C-S: reduces neonatal mortality by 1%.

Vaginal delivery if experienced (90% deliver easily)