Breech Flashcards
Situation
Sylvia is a 28 year old para 2+2 who has had two previous SVDS and two early miscarriages. She is married and a smoker with a BMI of 30kg/m. she has been diagnosed as having a breech presentation. She is now 37 weeks gestation and has presented at triage with uterine contractions. Sylvia has just had a SROM and the cervix is fully dilated. The fetal sacrum is not yet visible at the vulva but thick meconium is draining per vigina. The fetal heart is 50 bpm and there is 4 strong contractions per 10 mins.
What do you think may have happened in this scenario?
Breech delivery
What factors led you to this conclusion
Diagnosed in the antental period with breech
thick meconium
SROM
Parity
Demonstrate and discuss how you would manage this situation
Introduction- name student midwife
Ask if i can have a look underneath- confirm baby is coming bottom first.
Press emergency buzzer but explain its not urgent emergency to sylvia and babies can be born in this way
Call 2222- anethestist, charge midwife, neonatal team, doctor, alert theatre we might be coming.
Remove pillow and adjust
Get emergency trolly
Give SBAR to staff that entered.
Initial things to do
Put gloved and apron on
remove a couple of pillows
Cannulate- Incase the need to fluids or drugs. Using a grey cannula. using none touch a septic technique, cannualas in both arms, taking full blood count for platelets hemoglobin and white cell count, and a group and save in case of need for cross match. Use a sterile dressing over and make sure to date and time and get a trained professional to flush.
Catheter- Size 10 in out catheter to empty the bladder to give more room for the fetus to navigate the pelvis.
Get bed into correct position- legs into lethotomy, take end of bed off. Lithotomy help the baby go though the pelvis and for decent of buttocks
Can give her some pain relief- gas and air.
Delivering baby
Waiting for fatal buttock to appear at the vulva- encouraging sylvia to push
Hands off approach waiting for fetal buttocks to extend- at this point you can evaluate fro an episiotomy but ensure the buttock has passed the perineum to minimise bleeding.
Waiting to see if the legs will deliver- if they are extended and not flexed they need assistance to do so- which they are
Wait for the popliteal focla to be visible at the vulva
Apply two fingers onto the popliteal focla and apply pressure and abduct the leg down- done on both legs
Take hands off approach again- the body will now be delivered
Cord is now visible so want to ensure we aren’t touching as can cause spasm reducing blood flow to baby and can cause fetal distress.
Wait for shoulder to appear- if there is difficulty delivering shoulders- the arms are extended and need to use love set manoeuvre.
The aim of love set is to rotate baby 180 degrees and get the posterior arm to the anterior aspect- to free the shoulder under the symphysis pubis.
Hold baby thighs- Place two thumbs over the sacrum avoiding pressure on the abdomen as can cause injury to organs.
Keep baby’s back upper most but apply downwards traction while turning baby 180 and then doing this the opposite way.
The arm is extended so want to insert two fingers and flex the arm and sweep over the abdomen and repeat on both arm.
You then want to let baby hang allowing the pressure to help the head negotiate the pelvis.
Use towel to cover the baby to minimise baby getting cold quickly.
Then looking for baby nape of neck and hairline to appear- if not becoming visible the head is extended and hasn’t sweeped under the super public arch. Using the manoeuvre mauriceau-smellie-vein
We need to insert two fingers onto the babies maxilla and other hand onto babies occiput - letting the baby straddle my forearm, trying to avoid touching the cord. Flex the head which will realise the subosipital part of the head and come under the symphysis pubis.
Using slow traction upwards till baby is born. This is so we avoid intercranial damage and tares
there is another manuvous that can be down called burns Marshall but isn’t used in practise anymore as can cause neck fractures and spine
After delivery
Place baby onto mum wrapped in towel and allow neonatal tea to check over baby.
Double clamp to take cord bloods and gases.
Organise sylvia back onto bed
Document- time breech was diagnosed, 2222 call, who was present, what roles they done, when and what manoeuvres were taken place, when body was delivered, when baby was delivered, apgar scores, result of baby, Result of mum, blood loss, dugs given
Debrief mum and family
