Breech Presentation Flashcards
What is meant by breech position?
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
What are the 4 different types of breech position?
- complete / flexed
- incomplete
- Frank / extended
- footling
What is meant by a complete breech?
Who is more prone to this?
- 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
What is meant by an incomplete breech?
- one leg is fully flexed at the hip and knee
- one leg is flexed at the hip and extended at the knee
What is meant by an extended / Frank breech?
Who is more prone to this?
- 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
What is the management for breech babies before 36 weeks?
no intervention
- most babies will turn spontaneously prior to 36 weeks
What is the management for breech babies after 36 weeks?
- 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
What should women who want a vaginal delivery with a breech baby be told about?
- 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
What is different about management of birth when twins are involved?
if the first baby in a twin pregnancy is breech, caesarean-section is required
What is involved in external cephalic version (ECV)?
What is the success rate?
- 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
Who is offered external cephalic version (ECV)?
- after 36 weeks for nulliparous women (who have never given birth before)
- after 37 weeks for women who have given birth before
What medication must be given to women prior to external cephalic version (ECV)?
tocolysis with subcutaneous terbutaline
- this is a beta-agonist
- it reduces the contractility of the myometrium, making it easier for the baby to turn
What are the complications associated with ECV?
- pain
- transient fetal bradycardia
- feto-maternal haemorrhage
- antepartum haemorrhage (APH) / abruption
What is given to some women prior to ECV in case of feto-maternal haemorrhage?
anti-D prophylaxis
- typically 500 IU
- this is given to Rhesus-negative women
What monitioring is required during external cephalic version (ECV)?
- 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