Breech Flashcards
What is breech presentation?
Malpresentation - the feet or buttocks are the presenting part
What is the classification of breech?
- Frank breech
- Complete breech
- Incomplete breech (footling)
Describe each class of breech.
Frank - hips flexed and knees extended
Complete - hips and knees flexed
Incomplete (footling) - one leg protruding at the pelvis
At what gestation do babies turn cephalic?
32 weeks
What are the risk factors for breech?
- Uterine structure
- Multiparity, fibroids, uterine surgery - Altered foetal mobility
- Prematurity, macrosomia, twins, amniotic fluid - Pelvic block
- Pelvic mass, narrow pelvis, placenta praevia
What are the complications of breech?
Cord prolapse
Acute hypoxia during delivery
Trauma during delivery
How is breech prevented?
Postural management
Moxibustion (accupuncture)
How is breech managed?
- ECV
- Elective C-section
- Vaginal breech delivery
What is ECV and when it is it performed?
External Cephalic Version (manipulation of position through the maternal abdomen)
- Nullip = 36w
- Multip = 37w
What are 5 complications of ECV?
- Cord entanglement
- Foetal distress
- ROM or APH
- Pain and discomfort
- Failure
When is an elective C-section performed in a breech baby?
39 weeks (wait for baby to turn)
What is the criteria for a vaginal breech delivery?
Frank or complete breech (not footling)
Satisfactory growth (<3.5kg)
Adequate pelvis
No abnormality on U/S
Experienced clinician
What are the complications of a vaginal breech delivery?
Cord prolapse
Head entrapment
Trauma
Nuchal arm
Asphyxia
How is an unstable lie managed?
Admit at 37 weeks and aim to deliver at 39-40 weeks
If baby turns cephalic, wait for 48 hours to see if stable - discharge if <38w, IOL if >38w
