Breech delivery and ECV Flashcards
What percentage of SINGLETON pregnancies are breech presentation at term?
3-4%
What percentage of singleton breech pregnancies are delivered by LSCS?
97%
List maternal predisposing factors to breech presentation
Uterine abnormality e.g. bicornuate uterus, previous surgery. Uterine fibroids.
List fetal predisposing factors to breech presentation
Multiple pregnancy. Preterm. Abnormal liquor volume (oligo- and polyhydramnios). Fetal anatomical abnormality e.g. hydrocephalus, anencephaly. Fetal neuromuscular abnormality. Placenta praevia.
What important information can you get from performing an ultrasound in a baby that is breech presentation?
Presentation (flexed, extended leg breech; footling breech) Cord: presentation, tight nuchal cord. Placental location including if praevia. Liquor volume (oligo- or polyhydramnios). Hyperextension of fetal head. EFW (IUGR or LGA)
When should you offer a NULLIP an ECV?
From 36 weeks gestation.
When should you offer a MULTIP an ECV?
From 37 weeks gestation.
What serious adverse outcomes can result from an ECV and what is the percentage risk of these occurring?
Serious adverse outcomes: cord presentation, placental abruption, uterine rupture, fetal distress. Risk is 0.5%.
What minor complications can result from an ECV, and what is the percentage risk of these occurring?
Minor complications: transient CTG abnormalities, rupture of membranes, bleeding. Risk if 4.3%.
What is the overall success rate of ECV? How does being a nullip and multip affect this?
Overall success rate of ECVs is 50%; it is lower (40%) in a nullip and higher (60%) in a multip.
List the ABSOLUTE contraindications for performing an ECV
When Caesarean section is otherwise indicated. APH within the last 7 days. Ruptured membranes. Abnormal CTG. Major uterine abnormality. Multiple pregnancy (except during delivery of 2nd twin)
List the RELATIVE contraindications for performing an ECV
SGA with abnormal dopplers. Proteinuric preeclampsia. Oligohydramnios. Unstable lie (unless another indication to perform stabilising amniotomy/IOL at same time). Restrictive nuchal cord. Major fetal abnormalities. Scarred uterus (although after one LSCS there is no increased risk).
Briefly outline how you would counsel a women regarding ECV
Explain what ECV is and why it is offered. Success rate of ECV and low rates of reversion to breech and spontaneous turning to cephalic. Low risk procedure and list risks. Explain procedure and what to expect, including adjuncts (tocolysis, spinal).
A meta-analysis by Kok et al found what predictors were associated with successful ECV?
AFI >10. Maternal body weight <65 kg. Palpable fetal head. Posterior placental location. Non-engagement of the breech. Use of tocolysis. Flexed leg breech.
List the steps you’d take in preparing for and performing an ECV
Location of ECV must have:
- ultrasound, CTG
- facilities for Caesarean section.
- Who: must be trained in ECV or be under direct supervision of trained practitioner.
- Pre-ECV CTG.
- Perform ECV: max 4 attempts for max 10 mins overall.
- Post-ECV: immediately check FHR with USS. If normal, complete CTG.
- If abnormal, nurse in left lateral and prepare for Cat 1 LSCS after 6 mins of bradycardia.
- Give Anti-D to Rh negative women.