Breech

Question 1

Selection criteria for vaginal breech delivery

Answer 1

No contraindications for delivery

Foetal:
Fetal weight between 2.5-3.8
No structural abnormalities
No hyperextension of the fetal neck
No clinical evidence of cephalo-pelvic disproportion

Question 2

What is the management of fetal head entrapment?

Answer 2

Call for help - would get another senior obstetrician experienced with vagjnal delivery, senior midwives, obstetric midlevel staff, porters, anaes (increased risk of emergency lscs), paeds (increased risk of hypoxic brain injury and need for advanced neonatal resuscitation)
McRobert’s position as it increases pelvic diameters (flattens sacrum, increases anteroposterior diameter)
Suprapubic pressure
Mariceau-Smellie -Veit with suprapubic pressure applied
Transverse
Toxolysis with glycerine trinitrate
(To relax uterus and cervix
Attempt Forceps with Piper or Kieland forceps (midcavity)
- difficulty of

Question 3

What facilities are needed for ECV?

Answer 3

CTG - prior to and after to ensure normal FHR. Transient bradycardia expected post ECV.

U/S - to confirm that ECV was successful; can be done prior to ECV

OT- in cases of fetal compromise

Question 4

Contraindications to ECV?

Answer 4

Absolute contraindications:
Abnormal normal ctg
Csection indication
APH in last 7 days
Multifoetal gestation
ROM
Uterine anomalies

Relative:
Sga foetus with abnormal dopplers
Oligo
Major fetal anomalies
Scarred uterus

Question 5

Foetal risks of ECV

Answer 5

Cord prolapse
Head entrapment
Soft tissue injury
Long bone #
Hypoxic brain injury

Question 6

Risk of cord prolapse with breech presentations?

Answer 6

Cephalic 0.4%
Frank/complete 0.5%
Extended breech 5%
Footling 15%
Knee 15%

Question 7

Likelihood of reversion post ecv or likelihood of spontaneous version to ceph w/o ecv?

Answer 7

Post ecv 5%
Without ecv 8%

Question 8

Causes of persistent breech presentation?

Answer 8

Congenital abnormalities
Placenta localization (low-lying)

Question 9

What is external cephalic version?

Answer 9

ECV refers to manipulation of the fetus through the abdomen to convert a breech to cephalic presentation to decrease the risk of a csection or a vaginal breech delivery which is associated with increased perinatal morbidity.

Question 10

How to increase success to ECV?

Answer 10

Terbutaline
Second operation
Music therapy