Breech Presentation Flashcards
What is cephalic presentation ?
Head presents first
What is the breech presentation. ?
Presenting part is legs or buttocks
What are the 3 types of breech presentation ?
Extended (70%): legs are extended are the knee; flexed (15%): legs are flexed at the knee; Footling (15%): one or both of the legs present below the buttocks (high risk of cord prolapse)
What is the umbilical cord ?
Cord that runs from the belly button to placenta
What are the complications of a breech pregnancy ? (2) 😭
- Perinatal mortality and morbidity due to intrapartum problems: cord prolapse and head entrapment
- Congenital abnormalities: neurological handicap
What is the mnemonic for the risks for breech presentation and state what they are ? (7) 😭
Most cases are idiopathic and they are common in preterm babies. Only affects 3-4% of term babies
TUPO: Twins; Uterine fibroids/fetal abnormalities; Pelvic tumours/deformities/obstruction, previous breech, placenta praevia, polyhydraminos and Oligohydramnos
What is polyhydraminos ?
Excess amniotic fluid
What is oligohydraminos ?
Lower level of amniotic fluid for gestational age
If the Women is below 36 weeks what would you say to her
If below 36weeks reassure and mention that the baby can turn to a cephalic presentation and come back at 36 weeks
Describe the management options for a breech presentation
Discuss external cephalic version at 3weeks is first line provided no contraindications
Alternatives: elective c-section (39 weeks) and vaginal birth
When is ECV performed ?
At 36 weeks for nulliparous: 37 weeks for mulitparous, provided there are no contraindications
What is the mnemonic for the contraindications for ECV and state what they are ? 😭
FARTP; Fetal compromise, APH + placenta praevia; Ruptured membranes (water broken), Twins and previous c-section (classical or vertical)
What is ECV ?
External cephalic version is a procedure performed by an obstetrician at 37 weeks under US guidance, where gentle pressure is applied to the tummy in an attempt to turn the baby so that their head lies first
Reasons for ECV
Breech presentation
What are the procedure details ?
Before: check rhesus status and if negative give you anti D
During: give you a uterine relaxant but no anaesthetics are given
After: can distress the baby so fetal CTG is performed
What are the benefits of ECV ? (3)
50% success rate which means there there is also a possibility of it failing so baby remains in breech position
Reduces the risk of intrapartum problems
Less risky than a c-section or vaginal birth
What are the risks of ECV ?
- Small risk of induction of labour and if this the case you will need to have an emergency c-section (don’t worry we will be in hospital)
- Umbilical cord entanglement
3: placental abruption (haemorrhage/Bleeding)
Safety netting
If you go into labour, it’s important you come to hospital immediately as there is a high of cord prolapse
Alternatives to ECV
Elective c-section and vaginal birth
What is the benefit (1) and risk(2) of have an elective c-section for a breech pregnancy ? 😭
Benefits: Safer for your baby than a vaginal delivery
Risks: (2)
1. more risky for you
2.Increases your chances of problems for future pregnancies
What are the benefits (1) and risks of having a vaginal surgery (2) ?
Benefits: More safer for you
Risks: 1. small risk you may need emergency c-section
2. Risk of intrapartum problems (cord prolapse and head entrapment)
