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Obstetrics and gynaecology > Breech > Flashcards

Breech Flashcards

1
Q

Name the three different types of breech

A

Complete
Frank
Footling

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2
Q

What is the incidence of breech?

A

3-4% at term

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3
Q

Why is breech delivery best done on all fours?

A

Gravity
Increases pelvic diameter
Clear vision if manoeuvres required
Reduces second stage

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4
Q

What is breech?

A

Where the foetus presents either buttocks or feet first

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5
Q

Describe footling breech

A

Feet first

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6
Q

Describe complete (flexed) breech

A

Both legs are flexed at hips and knees - sitting cross legged with bum presenting

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7
Q

Describe frank (extended) breech

A

Bum first, both legs flexed at the hip and extended at the knee

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8
Q

What is the most common breech presentation?

A

Frank (extended)

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9
Q

At what gestation do we worry about breech?

A

> 32-35 weeks

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10
Q

List some risk factors for breech

A

Uterine

  • multiparity
  • uterine malformations
  • Fibroids
  • Placenta praevia

Fetal

  • Prematurity
  • Macrosomia
  • Polyhydramnios - raised amniotic fluid index
  • Twin pregnancy/or higher order
  • Abnormality
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11
Q

How is breech presentation usually identified?

A

Clinical examination - palpation or if foetal heart auscultated higher on the maternal abdomen

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12
Q

How can breech present during labour?

A

Fetal distress
Meconium stained liquor
Vaginal examination - sacrum or foot felt through cervical opening

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13
Q

List the three main differentials of breech presentation

A

Oblique lie
Transverse lie
Unstable lie

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14
Q

What is oblique lie?

A

Foetus is positioned diagonally in the uterus with the head or buttocks in one iliac fossa

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15
Q

What is transverse lie?

A

Foetus is positioned across the uterus with head on one side of pelvis and buttocks on another
Shoulder is the presenting part

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16
Q

What is unstable lie

A

Where the foetus changes presentation from day-to-day

17
Q

When is unstable lie more common?

A

Polyhydramnios

Multiparity

18
Q

How should any suspected breech presentation be investigated?

A

Ultrasound

19
Q

Describe the management of breech

A

External cephalic version (ECV)

Caesarean section

Vaginal breech delivery

20
Q

Describe external cephalic version

A

Manipulation of the foetus to a cephalic presentation through the maternal abdomen

21
Q

What is the percentage success rate of ECV?

A

40% in primiparous woman and 60% in multiparous woman

22
Q

List the complications of ECV

A

Transient foetal heart abnormalities - which revert to normal

Persistent rare heart rate abnormalities- fetal bradycardia

Placental abruption

23
Q

What is the risk of a woman needing C-section after ECV?

A

1/200

24
Q

Who is ECV contraindicated in?

A

Recent APH
Ruptured membranes
Uterine abnormalities
Previous C-section

25
Q

Which drug is given to relax the abdominal muscles before ECV?

A

Terbutaline

26
Q

Which birthing position is favoured in breech?

A

Semi recumbent or on all fours

27
Q

What kind of approach is required with breech delivery?

A

Hands off/poised

28
Q

Which women should not be offered caesarean section

A

Near or in active second stage of labour

29
Q

What is a contraindication to vaginal breech delivery

A

Footling breech - feet and legs can slip through a non dilated cervix and shoulders or head can be trapped

30
Q

Which 3 manoeuvres can be used to assist vaginal breech delivery?

A

Flexing the foetal knees to enable delivery of the legs

Lovsett’s manoeuvure to rotate the body and deliver the shoulders

Mauriceau-smellie-veit manoeuvre

31
Q

Describe the alignment of the baby to the mum when the mum is on all fours in breech delivery

A

Tum (baby) to bum (mum)

32
Q

What is it called when the bum is presenting?

A

Rumping

33
Q

How long do you have to get the baby out when it starts rumping?

A

7 minutes

34
Q

List the complications of breech presentation

A

Cord prolapse (1% in breech compared to 0.5% in cephalic)

Foetal head entrapment

Premature rupture of membranes

Birth asphyxia

Intracranial haemorrhage

Obstetrics and gynaecology (67 decks)

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