Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Malpresentation > Breech > Flashcards

Breech Flashcards

Green

1
Q

What is breech presentation?

A

Presentation of the buttocks of the foetus in the lower segment of the uterus/pelvis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What percentage of babies are breech at

a) 20w?
b) 28w?
c) term?

A

a) 40%
b) 20%
c) 3%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the causes/associations?

A

Idiopathic (most common)
Uterine abnormalities (e.g. bicornuate uterus, fibroids)
Prematurity
Placenta praevia
Oligohydramnios
Foetal abnormalities e.g. hydrocephalus
Conditions preventing movement (twin pregnancies, pelvic tumours, praevia, pelvic abnormalities) common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What form of breech is most common?

A

Extended breech (70%) - flexed hips, extended knees; presenting component buttocks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What other forms of breech are there?

A 
Fixed breech (15%) - hips and knees flexed, presenting component buttocks, external genitalia and feet
Footling breech (15%) - presenting component feet
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What complication is associated with footling breech?

A

Cord prolapse (5-20%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How does breech present antenatally?

A

Pain under ribs
Lie longitudinal on palpation, no head in pelvis
Head ballotable in fundus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How can breech be definitively diagnosed?

A

USS

vaginal exam if woman labouring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What percentage of breech is undiagnosed in labour?

A

30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the complications associated with breech?

A

Perinatal and long-term morbidity and mortality increased
Foetal abnormalities increased
Slightly increased risk neurological handicap
Hazards in labour (hypoxia, birth trauma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How can it be managed?

A

External cephalic version (ECV)

Managing mode of delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is ECV?

A

Turning baby to cephalic by external moving through a typically forward somersault. Should only be performed if a vaginal delivery is planned after 36-37w

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the success rate of ECV?

A

Primips - 40%

Multips - 60%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the contraindications of ECV?

A

Placenta praevia
Multiple pregnancy (except delivery of second twin)
APH in last 7d
Ruptured membranes
FGR
Abnormal CTG
Maternal uterine abnormality, uterine scars
Foetal abnormality
Pre-eclampsia, or HNT (inc risk of abruption)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What should be done in addition to ECV?

A

Monitor CTG

Give anti-D to Rh -ve mothers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How many ECVs are converted to emergency caesarean sections?

A

1 in 200

17
Q

How many successful ECVs will return to breech?

A

3%

18
Q

What may be given to the mother to make ECV easier?

A

Uterine relaxant (tocolytic)

19
Q

What factors indicate a less successful ECV?

A 
Nulliparity
Caucasian
Engaged breech
High uterine tone/head not easily palpable
Obesity
Low liquor volume
20
Q

Does the mode of delivery affect morbidity and mortality?

A

Neonatal morbidity and mortality is increased regardless of mode due to breech position (breech babies more likely to be preterm/congenital abnormalities)

21
Q

Which mode of delivery is better for baby?

A

LSCS has better outcomes (dec. risk of NICU admission?

22
Q

What mode of delivery should be performed in the case of twins?

A

1st twin breech - LSCS

2nd twin breech - vaginal

23
Q

What are the contraindications to vaginal breech delivery?

A 
Inexperienced clinician
Footling or kneeling breech
High (>3800g) or low (<2000g) foetal weight
Previous LSCS
Hyperextended foetal neck
24
Q

What approach should the clinician take in a vaginal breech delivery?

A

Hands off technique; don’t touch until scapulae visible
Attempt to keep spine anterior (Lovset’s procedure - with thumb on sacrum rotate baby 180 degrees clockwise, then counterclockwise with gentle downward traction)
Hook arm at elbow
Deliver head with Mauriceau-Smellie-Veit manoeuvre (two fingers of right hand on maxilla, two fingers of left on occiput to flex head)

25
Q

What operative methods can be used if manual vaginal delivery fails?

A

Forceps for head

Ventouse contraindicated

26
Q

What position is best for the mother to deliver if baby in breech?

A

All-fours (pelvic dimensions enlarge, aortocaval compression reduced, baby more visible when emerging)

27
Q

Should the mother push in vaginal breech?

A

Mother should only start pushing once buttocks visible

28
Q

Should oxytocin be used in mothers with poor cervical dilation?

A

Caesarean advised over syntocinon

29
Q

What should be checked once birth is complete?

A

Check for hip dislocation
USS at 6w to check for delayed presentation hip dislocation
If vaginal delivery, check for Klumpke’s paralysis (brachial plexus injury C8-T1, median and ulnar palsy,claw hand) and signs of CNS injury

30
Q

What tocolytic can be used in ECV?

A

Terbutaline

31
Q

What percentage of breech babies will spontaneously turn to cephalic without intervention?

A

8%

Malpresentation (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions