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Pathologic Obstetrics > Breech > Flashcards

Breech Flashcards

1
Q

Define breech presentation

A

When the buttocks or legs of the fetus enter the pelvis

before the head

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2
Q

T/F

Breech is more common when remote (preterm) from term

A

True

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3
Q

How many percent of breech presentation persist at term in singleton deliveries as the fetus turns spontaneously to cephalic presentation?

A

3-4% only

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4
Q

Reason why there is breech presentation

A

Fetus’s biparietal diameter is larger than breech “buttocks” so it would seek a more spacious hole which is the fundus, AT TERM.

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5
Q

3 Categories of Breech Presentation

A

Frank, Complete, Incomplete

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6
Q

The buttocks present in the introitus,
the thighs are FLEXED towards the lower
abdomen, and the legs are EXTENDED.

A

Frank

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7
Q

The thighs are FLEXED towards the lower
abdomen, and the legs are FLEXED
towards the thighs.

“Indian sit”

A

Complete

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8
Q

Reference point in all breeches

A

Sacrum

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9
Q

One or both thighs are FLEXED or

EXTENDED, and one foot is EXTENDED.

A

Incomplete

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10
Q

If the sacrum is palpated in Incomplete breech at the level of ischial spine, what is the station?

A

Station 0

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11
Q

Give 4 Risk factors for breech presentation

A 
Greater intrauterine surface area
Congenital anomaly
Decreased surface area at the lower intrauterine segment
Prior occurrences (Prior breech and prior CS)
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12
Q

Explain why greater surface area is a risk factor

A

There is a high probability that the fetus will tumble around the uterus especially in the setting of premature gestational age, abnormal amniotic fluid volume, high parity with uterine relaxation

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13
Q

Explain why congenital anomaly is a risk factor

A

Hydrocephaly and Anencephaly will seek a more spacious fundal pole

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14
Q

Explain why decreased surface area at the lower uterine segment is a risk factor

A 
In setting of multifetal gestation
Fundal placental implantation
Uterine/ Mullerian Anomalies (Bicornuate uterus or uterine didelphus)
Pelvic tumor
Placenta previa

Decreased surface area will seek a more spacious fundal pole

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15
Q

Diagnosis of Breech Delivery

A

Leopold’s Maneuver
Fetal Heart Sound
Vaginal Examination

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16
Q

Leopold’s Maneuver

L1 means

A

the fetal head will be felt as ballotable, hard

round mass, found to occupy the fundus

17
Q

What is the meaning of ballotable/ ballotment

A

“Bouncing back”

18
Q

Leopold’s Maneuver

L2 means

A

the same as in cephalic, the fetal back on one
side of the abdomen and fetal small parts on the
other will be felt

19
Q

Leopold’s Maneuver

L3 means

A

if engagement has not occurred, the
intertrochanteric diameter of the fetal pelvis has not
passed through the pelvic inlet. The breech is movable
above the pelvic inlet.

The breech will be felt as a very large podalic pole,
softer than the head.

20
Q

Leopold’s Maneuver

L4 means

A

after engagement, the firm breech is beneath

the symphysis

21
Q

In breech, it is heard loudest slightly at?

A

Above the umbilicus (upper segment)

because the head is up with
the upper torso

22
Q

In cephalic, it is heard loudest at?

A

LUS because that

is where the fetal back is

23
Q

In vaginal exam, what will you palpate for frank breech?

A

Ischial tuberosities, sacrum and anus

24
Q

Anus can be mistaken as?

A

Mouth

25
Q

Ischial Tuberosities can be mistaken as?

A

Malar eminences

26
Q

Difference in configuration of palpable ischial tuberosities and anus in breech vs cephalic?

A

Breech- straight line configuration

Cephalic- triangular (Malar eminence not ischial tuberosities)

27
Q

Most accurate information that will establish the diagnosis of position

A

Sacrum and its spinous process

28
Q

How will you know if it is the mouth or the anus that you are palpating?

A

Mouth of the baby will have pursing movement, anus will not.

29
Q

In vaginal exam, you know it’s complete breech when?

A

Feet maybe alongside the buttocks if you push a little bit more beyond the ischial tuberosities/sacrum/anus

Pathologic Obstetrics (3 decks)

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