Breech and cord prolapse Flashcards
What are types of breech presentation
Frank breech(*MC): both hips flexed, knees extended (feet are next to head, like a toe touch)
Complete breech: both hips and knees are flexed
Incomplete breech: one or both hips NOT completely flexed
When do most breeches occur
<28 weeks !
only 3-4% occur at term
What factors allow for normal cephalic presentation
normal anatomy
activity
amniotic fluid volume and placental location are normal
RF for a breeched position are
Pre-term gestation Hx of breech Uterine abnormality (fibroids, bicornuate) Placental abnormality (previa) Multiparity extremely high or low fluis AMA contracted maternal pelvis Fetal anomaly (hydrocephaly, ancephaly)
How do you diagnose breech
Will palpate soft mass (buttocks) in the lower uterine segment (basically wont feel hard skull)
US confirm fetal head at fundus
How do you manage breech
External cephalic version (manually turn baby) at 34-35 weeks
C-Section if unsuccessful
What is cord prolapse
Umbilical cord slips ahead of the presenting part and protrudes into cervical canal/vagina
-Dx by seeing cord or feeling it before presenting part
Is cord prolapse bad?
Yes, OB emergency!! the cord is very susceptible to compression and you could cause umbilical artery or vein occlusion= decreased fetal oxygen supply
What can cause cord prolapse
high outward flow of amniotic fluid
disengagement of presenting part (head starts pushing out, but goes back in)
Maternal/fetal RF for cord prolapse include
prolonged labor premature birth malpresentation low birth weight second twin low lying placenta pelvic deformity uterine anomaly
OB interventions that can cause cord prolapse include
Rupturing membranes
cervical ripening w/ waterballoon catheter
induce labor
manual rotation of head
IU pressure cath (measures uterine activity, need >250)
How do you manage cord prolapse
EMERGENCY C-section
