Breech

Question 1

What is the definition of a breech presentation?

Answer 1

The buttocks or lower extremity entering the pelvis first with a longitudinal lie, sacrum denominator and bitrochanteric (10cm) presenting diameter

Question 2

What is the incidence?

Answer 2

3-4%

Question 3

What types of breech are there?

Answer 3

extended/frank, flexed/complete, footling, knee

Question 4

What are predisposing factors?

Answer 4

multiple preg, prematurity, poly/olgo-hydram, grand multi, prev CS

Question 5

How can we tell if a baby if breech?

Answer 5

Feel buttocks - soft
Might feel anus
SROM - thick mec

Question 6

What might be counter to a VBD?

Answer 6

footling, raised dopplers, feral or placental abnormalities, IUGR, pre, large baby

Question 7

What is star gazing?

Answer 7

When the foetal neck is hyperextended

Question 8

What is considered a large baby?

Answer 8

over 3800g

Question 9

Mechanisms of a physiological breech birth?

Answer 9

Baby enters pelvis in SA
Buttocks meet resistence
RSL
Hip flexion
rumping
rotates to RSA
direct SA
rotate to LSA
direct SA
tummy tuck

Question 10

What are some things to watch out for?

Answer 10

chest cleavage, full perineum, chest bulging, genitals appearing first, descent and no rotation, gasping.

Question 11

What should be avoided?

Answer 11

epidural, FSE, active pushing, wiping away maternal faeces, over use of VE, waterbirth.

Question 12

Nuchal arms?

Answer 12

prayer hands, fingers on ribs/shoulder blades, slight lift. Rotate to SA, sweep down arm, rotate 180, sweep other arm, back to SA

Question 13

Franks nudge?

Answer 13

Hold baby gently round the shoulders, and pivot body back, away from sacrum.

Question 14

Mauriceau-Smellie-Veit (MSV)?

Answer 14

Place middle finger of one hand on occiput, Place index and ring fingers of other hand on cheek bones, Flex head and deliver baby

Question 15

Lovsett-manouvre?

Answer 15

lithotomy, rotate baby, release arm, rotate baby, release arm, MSV