Breech presentation Flashcards
Types of breech
Complete
Incomplete
Extended
Footiling
What is complete breech
legs fully flexed at hips and knees
What is incomplete breech
One leg flexed at hip, one extended at knee
What is extended breech
Frank beech - both legs flexed at hip and extended at knee
Folded in half
Pubic symphysis dysfunction
Moving in pregnancy is lose -> significatn pain in pregnancy
Footling breech
Foot presenting through cervix with leg extended
When is breech managed
After 36 weeks
When is breech managed
After 36 weeks
First step in managing breech
External cephalic version (ECV)
used at 37 weesk
Options if ECV fails for breech
Vaginal delivery - safre for mother
Elective C section = safer for baby
Chance of emergency C section when try vaginal delivery with breach
40%
When is a C section required in breech
If twins and first twin is breech
How successful is ECV
50%
WHen is ECV used in nullipaorus vs multiparous women
After 36 weeks - nulliparous
After 37 weeks - given birth naturally
What is given before ECV
Tocolysis with SC terbutaline
Anti D prophylaxis if rhesus negative mother
Complete contraindications for vaginal delivery
Transverse lie
Contracted pelvis
Placenta preiva
What is terbutaline and what does it do?
Beta agonsit
Reduces contractility of myometrium - easier for baby to turn
What breech is safer
Extended breech -bum presenting
Flexed breech - incomplete - with feet presentation -
head extended so can’t fit through
Why is it singificant rhesus status of mother in ECV?
If rhesus negative need to give anti-D prophylaxis
What test is performed to quantify foetal and maternal blood amount mixed?
Kleihauer test
How determine dose of anti D required before ECV in rhesus negative women
Kleihauer test - measure how much foetal and maternal blood mixing
Why are small babies high risk labour
Contraction of labour reduced blood supply ot lpacenta and therefore baby
