breech

Question 1

leopolds maneovure

Answer 1

to figure out the postion of the baby

1. fundal grip - to figure out whether its the feet or head - determine fetal lay
2. umbilical grip- to find the back (as you will place the hr monitor on this side)
3. pawlick grip - fetal presnetaion (can you life the babies head up with your fingers to see if head is engages IF YOU CAN - BABY IS NOT ENGAGED AND IF YOUC CANT BABY IS ENGAGED?
4. pelvic grip

Question 2

which breech presntation can you delivery vaginallay

Answer 2

compelte breech + frnak

Question 3

which breech presenation must you do CS

Answer 3

FOOTLING

Question 4

when are you msot likely to see frank

Answer 4

primi gravida as the uterus has very good tone and baby wont have that much room and abdmianl wall is very tight so legs go up

Question 5

what values does us tell you in general baby health

Answer 5

BPD - head
estimated weight of the baby
any congential anomies
breech presentation and what ttype (complete /incmplete)
localises the placenta
assesemtn of liquor volume(which is impotant if you wanted to do ECV you need to know the amount fo volume there)

Question 6

delivery of the head in assisted breech delivery methods

Answer 6

1. burns marhsall maneouvere
   2, mauriceau maneouvere

also can use piper forceps

Question 7

risk factors for breech

Answer 7

1. grand multiparity
2. uterine abnormalities (bircorneuate /seperate , fibroids
3. full bladder in labour
4. placenta previa
5. oligo/polyhydraminois
6. prematire baby

Question 8

diagnois of breech

Answer 8

ultrasound will type you the type

Question 9

ecv

Answer 9

is done when the baby is breech,

offered at 36 (primi) and 37 (multi)

manual procedure where an experienced physician attempts to turn the baby using their hands on the abdomen. It generally has around a 50% success rate. ECV is usually carried out under ultrasound guidance. The mother is given analgesia, tocolytics and Anti-D immunoglobulin (if required) during the procedure. If ECV is unsuccessful and the baby is still breech presentation at term, the mother may choose to deliver vaginally or via Caesarean section.

Question 10

absolute CI for ECV

Answer 10

Ante-partum haemorrhage has occurred in the last 7 days

Non-reassuring cardiotocograph

Major uterine abnormality

Placental abruption or placenta praevia

Membranes have ruptured

Multiple pregnancy (but may be considered for delivery of the second twin)

Question 11

RELATIVE CI to ECV

Answer 11

Pre-eclampsia

Maternal obesity

Oligohydramnios

Question 12

msot important causes o fbreech are

Answer 12

premature + placenta previa