Breech

Question 1

Factors where breech delivery not recommended?

Answer 1

a. Cord presentation.
b. Fetal growth restriction (EFW < 2800g)
c. Fetal macrosomia (estimated fetal weight >4000 g).
d. Footling breech presentation (1 or both hip[s] extended).
e. Clinically inadequate maternal pelvis.
f. Fetal anomaly likely to interfere with vaginal delivery.
g. Hyperextended fetal head.

Question 2

List pros of trial of labor (5 points).

Answer 2

-Decreased maternal morbidity compared to Cesarean section.
-Decreased maternal mortality compared to Cesarean section.
-Potential decreased risk to mother in subsequent labor and delivery.
-Potential decreased risk to baby in subsequent labor and delivery
-Excellent neonatal outcomes including no difference in long-term neurological outcomes between vaginal birth and cesarean section.

Question 3

What are the strategies for managing trapped after-coming parts?

Answer 3

-Avoid fetal traction.
-Avoid heavy sedation.
-Maximize maternal pushing efforts.
-Suprapubic pressure (Bracht).
-Reduction of nuchal arms (Lovset or Bichenbach maneuver).
-Mauriceau-Smellie-Viet maneuver.
-Piper forceps assistance.
-Symphysiotomy.