Breech Presentation Flashcards

1
Q

What is meant by breech position?

A

occurs when the presenting part of the fetus is the legs / bottom

occurs in < 5% pregnancies at term

this occurs instead of cephalic presentation - in which the head presents first

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2
Q

What are the 4 different types of breech position?

A
  • complete / flexed
  • incomplete
  • Frank / extended
  • footling
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3
Q

What is meant by a complete breech?

Who is more prone to this?

A
  • both legs are fully flexed at the hips and knees
  • more common in a multigravida
  • this is because there is less tone in the abdominal muscles, allowing more space for the legs to fall down lower
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4
Q

What is meant by an incomplete breech?

A
  • one leg is fully flexed at the hip and knee
  • one leg is flexed at the hip and extended at the knee
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5
Q

What is meant by an extended / Frank breech?

Who is more prone to this?

A
  • both legs are flexed at the hip and extended at the knee
  • this is more common in primigravida women
  • they have more tone in their abdominal muscles, which holds the legs in place
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6
Q

What is the management for breech babies before 36 weeks?

A

no intervention

  • most babies will turn spontaneously prior to 36 weeks
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7
Q

What is the management for breech babies after 36 weeks?

A
  • USS to confirm the breech position
  • external cephalic version (ECV) can be used at 37 weeks
  • if this fails, women are offered a choice between vaginal delivery and elective C-section
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8
Q

What should women who want a vaginal delivery with a breech baby be told about?

A
  • there is around a 40% chance that an emergency C-section may be required when vaginal birth is attempted

overall, vaginal birth is safer for the mother and C-section safer for the baby

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9
Q

What is different about management of birth when twins are involved?

A

if the first baby in a twin pregnancy is breech, caesarean-section is required

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10
Q

What is involved in external cephalic version (ECV)?

What is the success rate?

A
  • this is a technique used to attempt to turn the fetus from the breech position to the cephalic position
  • gentle pressure is applied to the abdomen to turn the fetus

it is about 50% successful

a CTG must be performed prior to any ECV procedure

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11
Q

Who is offered external cephalic version (ECV)?

A
  • after 36 weeks for nulliparous women (who have never given birth before)
  • after 37 weeks for women who have given birth before
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12
Q

What medication must be given to women prior to external cephalic version (ECV)?

A

tocolysis with subcutaneous terbutaline

  • this is a beta-agonist
  • it reduces the contractility of the myometrium, making it easier for the baby to turn
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13
Q

What are the complications associated with ECV?

A
  • pain
  • transient fetal bradycardia
  • feto-maternal haemorrhage
  • antepartum haemorrhage (APH) / abruption
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14
Q

What is given to some women prior to ECV in case of feto-maternal haemorrhage?

A

anti-D prophylaxis

  • typically 500 IU
  • this is given to Rhesus-negative women
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15
Q

What monitioring is required during external cephalic version (ECV)?

A
  • CTG should be performed prior to ECV
  • continuous US monitoring with a probe on the baby’s heart is performed
  • if there is PROLONGED bradycardia, the procedure is stopped
  • an emergency C-section is required

transient fetal bradycardia resolves spontaneously and the procedure can continue

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16
Q

What are the absolute contraindications to ECV?

A
  • placenta praevia
  • uterine malformations
  • ruptured membranes
  • abnormal CTG / Doppler
  • severe pre-eclampsia
  • abruption

if there are ruptured membranes, there is not enough space to turn the baby

17
Q

What are the relative contraindications to ECV?

A
  • active labour
  • oligohydraminos
  • fetal abnormality
  • maternal cardiac disease