Breech presentation counselling

Question 1

structure of counselling

Answer 1

types

risks

default mode delivery

RFs

Ix

Mx

vaginal delivery complications

follow-up

Question 2

risks of breech

Answer 2

baby: higher perinatal mortality & morbidity

pre-existing congenital malformation & increased risk of intrapartum trauma/asphyxia

Question 3

mode of delivery

Answer 3

c-sec default

Question 4

RFs breech

Answer 4

uterine anomalies
placenta praevia
abnormal pelvic anatomy
smoking, diabetes
multiple pregnancies, polyhydramnios/oligohydramnios
prev breech

Question 5

investigations

Answer 5

breech prior to 32 weeks has no clinical significance

subcostal tenderness, ballotable head in fundal area, foetal heartbeat loudest above random places

USS can confirm

Question 6

Mx

Answer 6

ECV >36 weeks ~50% success rate

tocolysis: beta-mimetics (salbutamol)

risks: generally rare // pain, transient foetal bradycardia, APH, abruption, feto-maternal haemorrhage (RhD)

continuous monitoring, USS, emergency c-sec available

if foetal HR<90 –> abandon procedure

Question 7

complications post vaginal delivery

Answer 7

PROM
cord prolapse
asphyxia
IC haemorrhage // brachial plexus injury

Question 8

follow up

Answer 8

increased risk congenital dysplasia of hip

Question 9

ECV contraindications

Answer 9

placenta praevia

uterine distortions

rupture membranes

abnormal CTGs/dopplers

severe pre-eclampsia

abruption