Breech presentation – classification.Mechanism of vaginal breech delivery. Complications of the mother and fetus. Flashcards
what is breech presentation?
breech presentation is when the foetus’s buttocks or lower extremities are the first to exit through the birth canal
before 28 weeks is it normal for the fetus to be in breech presentation ?
yes
when does the baby go into vertex position ?
as the fetus grows and tends to occupy more space it goes into a vertex position at 34 gestation week
what is the ethology to breech position ?
premature delivery
preventing spontaneous version - breech with extended legs , twins , oligohydroaminos
hydrocephalus
placenta praevia
contracted maternal pelvis
pelvic tumors that obstruct birth canal
what are the classification to breech delivery ?
there are three types of breech presentation -
frank ,
complete
incomplete- footling
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sacrum denominating factor -
left or right sacroanterioir
left or rightsacroposterioir
describe complete breech ?
has both thighs and knees flexed and baby is in a squatting position and the feet is close to the buttocks
describe incomplete breech
only one of the baby’s knee is flexed and one feet is close to the buttocks, however the other thigh is flexed however knee extended like frank
or footling - where the thigh and knee are extended
what is frank presentation
both thighs are flexed
however the knees are extended
feet lies close to the head
This is the most common type of breech position.
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how is breech presentation diagnosed ?
diagnosed using leopold manuevers
in frank - irregular small parts of the feet may be fewt by the side of the head
head is also non balottale unlike complete breech
lateral - Fetal back is to one side and the irregular limbs to the other
pelvic grip - frank breech is usually engaged during pregnancy while complete breech is not
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US - the best
Attitude of the head is especially checked —flexion or hyperextension important for decision making at the time of delivery
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during labour per vaginum
in frånk breech - anus , sacrum and ischial tuberosities can be palpated
complete breech - ischial tuberosities, sacrum and the feet by the sides of the buttocks
what are the clinical management of breech before labour begins ?
if breech is suspected after 36 weeks and prenatal record , prior us should be reviewed for uterine tumors , CPD, or fetal structure abnormalities
external cephalic version - after 36 weeks of gestation because of the tendency of the premature fetus to revert back spontaneously
there is a small risk for placental abruption and cord compression - in this case emergency c section should be performed
clinical management in labour for breech presentation ?
standard care now is for all breech presentation delivery to go through c section
why should all breech presentation go through c section ?
avoid umbilical cord prolapse , head entrapment , birth asphyxia , birth trauma
vaginal breech delivery is associated with increased perinatal mortality compared to planned c section
prerequisites for vagina breech delivery ?
following must be met for vaginal delivery :
fetus should being frank or complete breech presentation
feet never below buttocks
gestational age atleast 36 weeks and over
estimated fetal weight 2500-to less than 3500g
fetal head must be flexed
maternal pelvis adequately large- assessed by x ray pelvimetry or tested prior delivery.
Anesthesia is available and a cesarean delivery possible on short notice
presence of obstetrician experienced with vaginal breech delivery
how does vaginal delivery of the breech occur occur ?
in sacroanterioir complete breech
engagement is in the bitrochanteric diameter -10cm the oblique diameter if the inlet
with sacrum directed to iliopubic eminence
descend of the buttocks occur until the anterior buttock touches the pelvic floor
internal rotation of the anterior buttocks occur 1/8th circle, placing it behind symphysis pubis
further descend with lateral flexion of the trunk until anterior hip hinges at symphysis pubis which releases then the posterior hip
delivery of trunk and then the lower limbs
resuscitation -
sacrum anterior position
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biacromial diameter - 12 cm engages in theoblque diameter
anterior shoulder meets the pelvic floor first
- internal rotation 1/8 - shoulder now in aneroposterfioir diameter of the pelvic outlet
delivery of the posterioir shoulder followed by anterioir completed by anterioir flexion of the delivered trunk
Restitution and external rotation: anterior shoulder toward the right thigh in LSA and left thigh in RSA
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head
Engagement occurs either through the opposite oblique diameter as that occupied by the buttocks or through the transverse diameter.
The engaging diameter of the head is suboccipitofrontal (10.5 cm).
Descent with increasing flexion occurs.
Internal rotation of the occiput occurs anteriorly, through 1/8th or 2/8th of a circle placing the occiput
behind the symphysis pubis.
Further descent occurs until the subocciput hinges under the symphysis pubis.
Head is born by flexion—chin, mouth, nose, forehead, vertex and occiput appearing successively.
how is the delivery of the legs and lower limbs ?
if flexed occurs spontaneously
if extended pinard’s manuever
