Breech and Dystocia Flashcards
What is a Breech Birth?
Part of the foetus is a different presenting part; the breech can be extended, flexed or footling
Usually recognised in scans or can tell with thick meconium at the entrance. Cord prolapse is also more common with a breech birth.
What is the Hands off Approach with Breech Births?
- Assess presenting part
- Call for a midwife/backup
- If see just a foot do not ask them to push
- Expect resus if delivered
- Try and use gravity as much as possible with positioning
- More ideal position for breech birth is buttocks presenting and are able to stay on scene with this presentation
- Once buttocks are born you have 5 minutes to get the entire baby out otherwise outcome is poor
What to do Whe Delay From; Legs
Apply gentle pressure behind the baby’s knee’s enabling the birth of each individual leg
What to do Whe Delay From; Arms
- If the arms are extended, gently rotate the baby by the pelvis so the shoulder is at the top of the abdomen
- Insert a pringle hand into the vagina and feel along the arm for the elbow
- Hook and draw the arm down and across the babies body
- Repeat on other arm by twisting the baby again by the pelvis if needed
- Once both delivered, rotate the baby to face the correct direction (face down)
What to do Whe Delay From; Arms
AND
Mother is in All Fours Position
- Rotate baby so baby is facing upwards
- Shoulder press but placing both hands against the babies chest and apply pressure to flex the babies head forwards as the mum pushes
What to do Whe Delay From; Arms
AND
Mother is in Semi-Recumbent Position
- This is known as the Mauriceau-Smellie manouvre
- Make sure baby is facing downwards
- Place one hand through to the cheekbones of the baby and the other upwards to its neck and head, cupping as much as possible
- Apply firm pressure to the back of the baby’s head and bring the chin towards the chest at the same time to flex the babies head
- Raise the baby’s down, around then upwards round the curve of the pelvic bone (see diagram)
What is Shoulder Dystocia?
An unpredictable obstetric emergency where there is difficulty encountered in the delivery of the fetal shoulders after deliver of the head. This is due to the impaction of the fetal shoulder behind the symphysis pubis
Incidence of Dystocia is Higher In…
- Diabetes (increases chance by 2 to 4%)
- BMI over 40
- Previous dystocia (10times more likely)
Si
Signs of Shoulder Dystocia
- Head is delivered
- Body is not then delivered with the next two contractions
- Chin is not free and baby seems very squished
- The head remains tightly applied to the vulva and retracts (turtling)
Alogirthm of Shoulder Dystocia
- Get women into position with McRoberts Manoeuvre
- Axial Traction
- Suprapubic pressure (constant or rocking)
- On all fours positioning
- Removal of the posterior arm (we are trained)
- Transfer in lateral position
What is the McRoberts Manouvre? Whats it do?
- chest
- This tilts the pelvis, widening the angle and straightening the birth canal creating more room for the shoulder to pass
- Ask the women to push with the next contraction then move on
How to Perform Axial Traction
- Cup baby’s head and pull gently away from the mother in the same plane, not up or down
- Don’t twist as this can damage the brachial plexus nerve
- If undelivered in 30 seconds move on
- This will work in 95% of cases
How to Perform Suprapubic Pressure
- Identify which way the baby is facing
- Place CPR style hand on the mothers abdomen above the pubic bone
- Apply moderate pressure angled towards the baby’s arm closest to mums tail bone (posterior arm)
- Continue for 15-30 seconds then with rocking motion
- Encourage mum to push
- DO NOT apply fundal pressure
All 4’s Positioning
- Position women onto her hands and knees with her hips well flexed
- Encourage movement and rocking back and forth to help dislodge
- Apply some more axial traction to see if that works
- This prepares for removal of the posterior arm
