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MRCOG Part 2 > Breech GT20a and b > Flashcards

Breech GT20a and b Flashcards

1
Q

What % of term deliveries are breech?

A

3-4%

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2
Q

By how much does ECV reduce the chance of breech presentation at delivery?

A

RR 0.38

NNT 2

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3
Q

What % of primips will have spontaneous versoin after 36/40?

A

8%

3-7% after unsuccessful ECV

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4
Q

What is the quoted success rate of ECV?

A

50% (30-80%)

40% pri; 60% multips

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5
Q

When should ECV be offered?

A

36/40 in primips
37/40 in multips
No upper limit - could be labouring as long as membranes intact

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6
Q

What are the complications of ECV?

A

Placental abruption
Uterine rupture
Fetmaternal haemorrhage
0.5% rate of immediate C/S

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7
Q

What are the absolute contraindications of ECV?

A

-Where C/S is required for other reasons
-Placental abruption
-APH in last 7/7
-Abnormal CTG
-Major uterine anomaly
-PROM
-Multiples (except for delivery of 2nd twin)
-Abnormal Doppler/CTG
-severe PET
-Rhesus isoimmunisation

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8
Q

What are the relative contraindications of ECV?

A 
SGA with abnormal Dopplers
Proteinuric PET
Oligohydramnios
Major fetal anomalies
Scarred uterus
Unstable lie but may be considered in context of stabilising IOL
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9
Q

What is moxibustion?

A

Burning dried mugwort at tip of 5th toe (acupuncture point) ?promotes spontaneous version but no strong evidence for use

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10
Q

What % of babies are breech at 28 weeks?

A

20%

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11
Q

What was the evidence from the Term Breech Trial of planned C/S on perinatal mortality and early neonatal morbidity compared with planned VB at term? And long term?

A

Reduces both - but ?could strategies for management of breech delivery negate these?

No evidence long term health of baby is influenced by how the baby was born

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12
Q

What was the evidence from the Term Breech Trial on effects of planned CS vs VB for mum?

A
  • Small increase risk in serious immediate complications than VB
  • No additional risk to long term health outside pregnancy
  • Long term effects of planned CS on future pregnancy outcomes uncertain - 44% incr risk further CS, less urinary incontinence, incr abdo pain but less perineal pain; more constipation at 2 years
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13
Q

What are the unfavourable factors for safe vaginal breech delivery?

A
  • Other contraindications e.g placenta praevia
  • Clinically inadequate pelvis
  • Footling/kneeling breech
  • Large baby >3.8kg
  • IUGR <2kg
  • Hyperextended fetal neck in labour
  • Lack of trained staff at delivery
  • Previous CS
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14
Q

What is the rate of ‘interlocking’ of breech/ceph twin?

A

1 in 817

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15
Q

In what % of cases is 2nd twin non-vertex?

A

40%

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16
Q

What is the NNT for planned CS vs vaginal birth for a term breech to prevent one postnatal death/serious neonatal morbidity in the first 6/52

17
Q

To what is the reduction in perinatal mortality attributed in planned CS for breech presentation?

A
  1. Avoidance of stillbirth >39/40
  2. Avoidance of vaginal birth
  3. Avoidance of risk of breech delivery
    (The only one unique to breech)
18
Q

What are the perinatal mortality rates with

  1. Planned cs >39/40 for breech
  2. Planned vaginal birth with breech
  3. Cephalic vaginal birth
A
  1. Planned cs >39/40 for breech - 0.5/1000
  2. Planned vaginal birth with breech - 2/1000
  3. Cephalic vaginal birth - 1/1000
19
Q

What are the short and long term risks of vaginal breech?

A

Increased risk of serious short term complications and low Apgars but no increase in long term morbidity

20
Q

What % of women planning a vaginal breech birth will need an emergency Caesarean section?

21
Q

Which factors will contribute to a higher risk planned vaginal breech birth?

A
  1. Hyperextended neck on uss
  2. EFW>3.8 kg
  3. EFW<10th centile
  4. Footling breech
  5. Evidence of antenatal fetal compromise
22
Q

What is the guidance re: iol and augmentation with oxytocics with breech delivery?

A

IOL generally not recommended

Synt only in context of poor contractions with epidural anaesthesia

23
Q

What is the recommendation with regards to breech first twin?

A

Recommend elective CS but not routinely emergency CS if in spontaneous labour

24
Q

What were the main criticisms of the term breech trial?

A
  • 31% had no uss to exclude extended neck
  • iugr babies included
  • a few women randomised in violation of protocol
  • senior obs absent from 32% births and any obs absent from 13%
  • efm not used in most
  • prolonged active 2nd stage not prohibited
  • perinatal death of at least 1/1000 cephalic or breech babies would have been prevented by eliminating last 1-3 wks preg and labour by cs at 39/40

MRCOG Part 2 (97 decks)

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