Abnormal Lie & Breech Presentation Flashcards
Management of Unstable Lie
No management necessary until 37 weeks
> 37 weeks –> admitted to hospital in case membrane rupture
ECV can bet attempted >37 weeks
Abnormal lie normally stabilises before 41 weeks
If labour or persistent abnormal lie –> C-section
Causes of Breech
Buttock presentation: buttocks occupy lower segment of uterus/pelvis
3% of term pregnancies
More common in pregnancies that restrict movement:
Uterine abnormality
Multiple pregnancy
Also due to conditions that prevent passing of head through into the pelvis:
Placenta praevia
Pelvic tumours
Pelvic deformities
Management of Breech
Do nothing up to 37 weeks
> 37 weeks admit to hospital
USS
Attempt to correct:
ECV
If failed –>
Cesarean Section
Breech vaginal delivery
External Cephalic Version
> 37 weeks, attempt to turn baby form breech into cephalic presentation
50% Success Rate
3% turn back to breech after successful ECV
Only 3% turn cephalic spontaneously after failed ECV
Technique
Administer tocolytic if uterine tone is high OR previous failed attempt
Breech is disengaged from pelvis by upwards (from inferior) and lateral pushing with two hands
Forward somersault
USS guided
CTG performed before and after
Anti-D given if Rh neg
Complications
Reported cases of perforation and abruption
Leads to emergency c-section in 0.5% - always monitor with CTG afterwards
Less successful: Nulliparous Caucasians Breech engaged Head not easily palpable High uterine tone Obese Reduced liquor volume
Contraindications Compromised fetus Any contraindication to vaginal delivery Twins ROM Antepartum haemorrhage
Cesarean Section when Breech
If ECV failed or contraindicated –> C-section safest method of delivery
Reduces neonatal mortality by 1%
Reduces short-term morbidity
1/3 breech vaginal deliveries end up as emergency c-section
Vaginal Delivery for Breech Presentation
More risky if: >4kg baby Evidence of fetal compromise Extended head Footlings legs
Pushing not encouraged until buttocks visible
30% have slow cervical dilatation in first stage and poor descent in second stage –> c-section
