Antenatal Care: Breech Presentation, Stillbirth & Cardiac Arrest Flashcards
What does the breech presentation refer to?
Breech presentation refers to when the presenting part of the fetus (the lowest part) is the legs and bottom.
What does the cephalic presentation refer to?
Where the head is presenting first.
Frequency of breech presentation?
occurs in <5% pregnancies by 37 weeks gestation.
What are the 4 types of breech?
1) Complete
2) Incomplete
3) Extended
4) Footling
What is a complete breech?
Where the legs are fully flexed at the hips and knees
What is an incomplete breech?
With one leg flexed at the hip and extended at the knee
What is an extended breech?
Also known as frank breech.
Both legs flexed at hip and extended at knee.
What is a footling breech?
A foot is presenting through the cercix with the leg extended.
Management of babies that are breech before 36 weeks?
These often turn spontaneously - no intervention is advised.
Management options of babies that are breech at term (37 weeks)?
1) External cephalic version (ECV): can be used at term (37 weeks) to attempt to turn the fetus.
If ECV fails:
2) Choice of vaginal delivery or elective caesarian section.
Vaginal birth vs caesarian section in breech babies?
Overall, vaginal birth is safer for the mother, and caesarean section is safer for the baby.
There is about a 40% chance of requiring an emergency caesarean section when vaginal birth is attempted.
What delivery is required when the first baby in a twin pregnancy is breech?
Caesarian section is required
What is external cephalic version (ECV)?
A technique used to attempt to turn a fetus from the breech position to a cephalic position using pressure on the pregnant abdomen.
It is about 50% successful.
Success rate of ECV?
50%
When is ECV used in babies that are breech (i.e. how many weeks)?
a) for nulliparous women
b) for women that have previously given birth
a) After 36 weeks for nulliparous women
b) After 37 weeks in women that have given birth previously
What are women given prior to ECV?
Tocolysis
Purpose of tocolysis prior to ECV?
To relax the uterus before the procedure
What is tocolysis? What medication is used?
Tocolysis is with subcutaneous terbutaline.
What is terbutaline?
Beta agonist (similar to salbumatol)
mechanism of terbutaline in ECV?
Reduces the contractility of the myometrium, making it easier for the baby to turn.
What do rhesus-D negative women require before ECV?
Anti-D prophylaxis
What test is used to determine the dose of anti-D required prior to ECV in rhesus-D negative women?
A Kleihauer test
What % of babies are breech:
a) at 28 weeks
b) near term
a) 25%
b) 3%
What type of breech position is most common?
Frank breech (hips flexed and knees fully extended)
Risk factors for breech presentation?
1) uterine malformations, fibroids
2) placenta praevia
3) polyhydramnios or oligohydramnios
4) fetal abnormality (e.g. CNS malformation, chromosomal disorders)
5) prematurity (due to increased incidence earlier in gestation
What is cord prolapse?
An umbilical cord prolapse happens when the umbilical cord slips down in front of the baby after the waters have broken.
What complication is more common in breech presentation?
Cord prolapse