Case Study 5 - Breech presentation and Cord Prolapse Flashcards
What are the potential causes or risk factors for breech presentation?
Causes/RFs for breech can be divided into
Fetus - chromosomal abnormality, tumour preventing engagment, macrosomia or prematurity
Placenta - praevia
Fluid - poly/oligohydramnios
Maternal - Uterine fibroids, bicornuate or septate uterus; external mass - constipation
What are the types of breech?
Frank breech - knees extended - most common, most favourable
Complete breech - knees bend/legs crossed i.e. complete
Footling - foot first - risk cord prolapse!!
What are the potential complications of breech delivery?
Difficult delivery - injury to baby e.g. erb’s palsy, fracture or liver rupture
Prolonged labour - fetal distress or maternal infection
Cord prolapse in case of footling presentation - birth asphyxia and stillbirth
What investigations should be performed in a woman with breech presentation at antenatal check?
Check - prenatal screening for risk of chromosomal abnormality, plus morphology scan
USS - fetal growth and development plus positioning, placental position and liquor volume
How common in breech presentation?
Incidence 20% at 28 weeks, to 3-4% at term - i.e. most babies undergo spontaneous version to cephalic.
How should breech presentation be managed?
From 28-36 weeks - wait and see - most babies will turn spontaneously
At gestation 36 nulliparous, 37 multiparous - offer external cephalic version (ECV)
What is the success rate of ECV?
Approx 50-60% successful. After successful ECV, reversion occurs in only 5%.
What are the potential complications of ECV?
ECV carries a small risk of placental abruption, uterine rupture and fetomaternal haemorrage. Rate 1/200 emergency CS
When must ECV not be performed? (Absolute contraindications)
What are the relative contraindications?
Ruptured membranes APH last 7 days major uterine abnormality Abnormal CTG multiple pregnancies
Relative - SGA or major fetal anomaly, oliguria, PET, scarred uterus, unstable lie
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