Breech

Question 1

What breech presentations are there?

Answer 1

Frank, complete, footling.

Question 2

Incidence rate

Answer 2

RCOG (2017) 3-4% term breech. Higher with preterm.

Question 3

Risk factors

Answer 3

Primip, placenta previa, multiple pregnancy, uterine abnormalities, previous breech.
Premature, macrosomia, polyhydramnious, hydrocephaly.

Question 4

Increased risk of…

Answer 4

PPH and NNR. prepare for both with active third stage and resuscitaire prepped and ready.
Increased risk of cord prolapse

Question 5

Can be diagnosed A/N how many undiagnosed?

Answer 5

8% of breech undiagnosed, identified with high FH on IA or on VE (no fontanelles, sutures or genitals felt)

Question 6

When to pull the emergency bell?

Answer 6

concerns over FH/ footling presentation

Question 7

Why is the all 4’s position recommended?

Answer 7

Increases the pelvic diameter and utilises gravity.

Question 8

How long from rumping?

Answer 8

7 minutes to deliver from rumping to avoid hypoxic damage. Continually assess colour and tone.

Question 9

The concern of breech delivery

Answer 9

The possibility that there will be longer exposure to hypoxia due to cord compression. This can result in HIE if for extended periods of time.

Question 10

How long from birth of umbilicus?

Answer 10

3 minutes to avoid hypoxic damage.

Question 11

The baby is rumping but not further progress what do we do?

Answer 11

encourage maternal movement,

Question 12

Legs are not spontaneously delivering what do we do?

Answer 12

Apply pressure into the popliteal fossa so the knee bends and then leg can be drawn out. Continually assess colour and tone.

Question 13

If no umbilical cleavage and spontaneous delivery of the arms what do we do?

Answer 13

Commence lovesets, rotate at pelvis 90 degrees and deliver anterior arm, pressure in the antecubital fossa to flex elbow and sweep across chest. NOT TRACTION. Rotate 180 degrees for other arm.

Question 14

What if head doesn’t deliver spontaneously?

Answer 14

Usually due to poor flexion, aim of the maneuver is to restore flexion. Mauriceau- Smellie -Viet. Hand along the back, middle fingers onto occiput. Other hand along baby abdomen index and ring finger on cheekbones. Flex head and gentle downwards traction to pivot under symphysis pubis. Can use SPP also if still not delivering.

Question 15

Until when is a c-section possible?

Answer 15

Until delivery of the umbilicus. Forceps delivery if head entrapment.

Question 16

After care

Answer 16

Cord Gases.
Hypo pathway due to risk of compromise.
NIPE by paed with attention to hips.
Suturing for mum
Normal PN care, pain relief, VTE score adjusted if necessary, BFS.
Document DATIX debrief. After action review.