Abnormal Lie/Breech Flashcards
what is the definition of the foetal lie
the babies relation to the longtitudinal axis of the uterus (longtitudinal/oblique/transverse)
what are the types of presentation with a longitudinal lie
cephalic (head first) or breech (feet first)
when is abnormal lie more common in labour
preterm labour polyhydramnios multiple parity multiple birth foetal/uterine abnormalities placental praevia pelvic tumours
what are the complications of abnormal lie
Reduced engagement and inability to deliver during labour
Prolapse of the cord and uterine rupture if this is neglected
Foetus and mother are at risk
what is the management of abnormal lie
Nothing for unstable/transverse lie <37 weeks unless the woman is in labour
> 37 weeks women are usually admitted in case the membranes rupture and USS is performed to exclude particularly identifiable causes
Polyhydramnios
Placental praevia
ECV not indicated as foetus may turn back
Spontaneous version lasting >48 hours = discharge
In the absence of pelvic obstruction an abnormal lie will stabilise within 41 weeks
At 41 weeks, or if the woman is in labour, the persistently abnormal lie is delivered by C-section
whats the prevalence of breech presentation in normal, and preterm births
3-4%, 25%
what are the subtypes of breech presentation with %s
Extended (70%)
Both legs extended at the knee + flexed at the hip
Flexed (15%)
Both legs flexed at the knee
Footing (10%)
One of both feet present below the buttocks
what is a common maternal complaint in pregnancies with an abnormal lie
upper abdominal discomfort
what are common complications of abnormal lie during birth
Long term and perinatal morbidity are increased
Foetal abnormalities more common
Labour has additional hazards of hypoxia and birth trauma
what is extracephalic version
procedure used from 37 weeks if a foetus is persistently in an abnormal lie
what is the succcess rate for an ECV procedure in abnormal lie
50%
what is given to the mother before an ECV is performed
tocolytic, anti-D if required, CTG performed before/after
what patients have a lower success rate for ECV
Nulliparous women
Head not easily palpable
High uterine tone
Obese women
Reduced liquor volume
Engaged breech position
Caucasians
when is ECV contraindicated
Ruptured membranes
Antepartum haemorrhage
Foetal compromise
Vaginal delivery contraindicated
Praevia
Twins
what is the advice surrounding delivering a baby in breech presentation
C section typically but vaginal delivery is possible If the woman wishes
Vaginal birth is risky in babies >3.8kg as there may be some head/leg lengthening or foetal compromise
Pushing is discouraged until the buttocks are visible and CTG is advised
