Breech presentation Flashcards
what is breech presentation?
when the presenting part of the foetus is the feet/bottom, rather than the head
risk factors for breech presentation
foetal abnormality
prematurity
oligohydramnios
polyhydramnios
uterine abnormality (including fibroids)
placenta praevia
what is…
complete breech
extended breech
footling breech
incomplete breech
foetus looks like its about to do a cannonball
foetus looks like it is folded in half in the middle
foetus’s foot has descended into the pelvis
both hips are flexed; one knee is flexed and one knee is extended
most common type of breech
breech carrying higher perinatal morbidity
most common is frank/extended breech
a complete or footling breech carries a higher rate of perinatal morbidity
cause of foetal distress which is higher in breech presentation
cord prolapse
by what point of the pregnancy do breech foetuses usually turn spontaneously?
36 weeks
at what point during the pregnancy should ECV be attempted? (2)
36 weeks for nulliparous patients
37 weeks for multiparous patients
% success of External Cephalic Version
60%
true or false: all vaginal deliveries for breech babies will require specialist management
rue; a team of experienced midwives and obstetricians will be required
how frequently does a breech presentation + vaginal delivery result in an emergency caesarean?
40% of the time!!
breech twins - how should they be delivered?
when the first twin is breech, a caesarean is required
which medication should be given to aid ECV?
subcutaneous terbinafine (a tocolytic)
how does terbinafine work?
it is a beta agonist and it reduces the contractility of the myometrium
injection required for some pregnant patients after ECV
anti-D (!)
6 absolute contraindications to ECV
multiple pregnancy
abnormal cardiotocogram
ruptured membranes
major uterine abnormality
antepartum haemorrhage last 7 days
caesarean is required
