breech_presentation_flashcards

Question 1

What is the prevalence of breech presentation at 28 weeks and at term?

Answer 1

1 in 4 breech at 28 weeks, 3-5% still breech at term.

Question 2

What should be done if breech presentation is detected at <36 weeks?

Answer 2

Wait and re-scan at 36/40 weeks.

Question 3

What is offered if the fetus is still breech at 36 weeks?

Answer 3

Offer external cephalic version (ECV) to all women unless there is an absolute contraindication.

Question 4

When is ECV performed for nulliparous and multiparous women?

Answer 4

At 36 weeks if nulliparous, or 37 weeks if multiparous.

Question 5

What is the success rate of ECV?

Answer 5

50%.

Question 6

What do rhesus negative mothers require if undergoing ECV?

Answer 6

Anti-D immunoglobulin.

Question 7

What are the contraindications for ECV?

Answer 7

Required C-section delivery, abnormal CTG, major uterine anomaly, recent antepartum haemorrhage, ruptured membranes, multiple pregnancy.

Question 8

What are the risks associated with ECV?

Answer 8

Failure (50%), foetal distress or bradycardia, antepartum haemorrhage, emergency C-section (1 in 200), placental abruption, premature rupture of membranes.

Question 9

What should be done if ECV is unsuccessful or declined?

Answer 9

Counsel about risks and benefits of vaginal breech delivery vs elective C-section.

Question 10

What are the benefits and risks of a C-section for breech presentation?

Answer 10

Small reduction in foetal mortality and neonatal morbidity, small increase in risk of immediate maternal complications, implications on future pregnancy.

Question 11

What are the benefits and risks of vaginal breech delivery?

Answer 11

40% risk of emergency C-section, slightly increased risk to foetus compared to elective C-section, factors affecting success and risk include foetal size, multiparity, mental attitude, neck extension, and foetal weight.

Question 12

What are the absolute contraindications for vaginal breech delivery?

Answer 12

Footling breech.

Question 13

What are the risk factors for breech presentation?

Answer 13

Uterine malformations, fibroids, placenta praevia, poly/oligohydramnios, foetal anomaly, prematurity, multiple pregnancy, nulliparity.

Question 14

What should be explained to the patient about breech presentation?

Answer 14

Explain what breech means and discuss the benefits and risks of vaginal breech delivery and C-section.

Question 15

What is recommended for vaginal breech delivery regarding induction of labour?

Answer 15

Induction of labour is not recommended.

Question 16

What are the recommendations for place of delivery and monitoring in vaginal breech delivery?

Answer 16

Advise to deliver in labour ward with continuous CTG monitoring.

Question 17

How does epidural analgesia affect vaginal breech delivery?

Answer 17

Increases the likelihood of intervention being necessary.

Question 18

What maternal positions are recommended for vaginal breech delivery?

Answer 18

All fours or semi-recumbent.

Question 19

What is the ‘hands off’ approach in the delivery of buttocks in vaginal breech delivery?

Answer 19

Avoid handling the baby; if needed, place thumbs on sacrum and fingers on ASIS.

Question 20

What is the Pinard’s manoeuvre?

Answer 20

Poke the baby in the popliteal fossa to make them bend their knees if the legs are extended.

Question 21

What is the Loveset’s manoeuvre?

Answer 21

Rotate the baby into the transverse position and pull the anterior arm down, then rotate to the opposite anterior position and pull the other arm down if the shoulders are stuck.

Question 22

What is the Mauriceau-Smellie-Veit manoeuvre?

Answer 22

Rest the baby on your forearm and pull the head downwards; use forceps if this doesn’t work.

Question 23

What other considerations should be made during vaginal breech delivery?

Answer 23

G&S, X-match, FBC, CTG, make sure theatre is ready.

Question 24

What is the recommendation for twin breech delivery?

Answer 24

Planned C-section if first twin is breech; routine C-section is not recommended if presenting twin is cephalic and second is breech.