CBL 9 - Breech Flashcards
What is the biggest risk of malpresentation?
Cord prolapse
What is the biggest risk of malpresentation?
Cord prolapse
What is malpresentation?
The part that is in the pelvis, ex. Breech, transverse
What is malposition?
How the head is positioned, ex OP
Factors associated with malpresentation? (6)
- High order parity (pendulous abdomen)
- Contracted pelvis
- Malformations of uterus
- Altered placentation
- Extremes of amniotic fluid (poly or oligo)
- PROM
Risks of malpresentation? (7)
- Cord prolapse
- Labour dystocia
- Maternal trauma
- Surgical/instrumental birth
- PPH
- Fetal morbidity
- Perinatal mortality
What is the denominator of face presentation?
Mentum
Can mentum be born vag?
Yes, if in mentum anterior
Can brow be born vag?
No
Can shoulder be born vag?
No
What are some malpresentations in labour?(6)
- Face,
- brow,
- breech,
- shoulder,
- compound cord
- unstable lie
How common is breech?
3-4 %
What is the most feared outcome of vag breech birth?
Entrapment
What are the types of breech presentation?
- Frank
- complete
- footling
What is frank breech?
Buttocks in pelvis with hips flexed, knees extended, feet toward had
Most favourable for breech vag birth
What is complete breech?
Fetal buttocks in pelvis with both hips and knees flexed.
Squatting, sitting cross legged
What is footling breech?
Fetal hips are deflexed and both or one knee is extended resulting in both/one foot presenting.
Not favourable for vag birth
More likely for prolapsed cord and irregular dilating surface, fetal entrapment
Contraindications for ECV? (9)
- C/S birth indicated
- Antepartum hemorrhage in last week
- Ab EFM
- Major uterine anomly
- Multiple pregnancy
- Preclampsoa
- Small for GA, ab dopplers
- Oligo
- Major fetal anomolies
Success rate for ECV?
30 % nulips
58% multips
What should be done prior to an ECV?
Rh immunoglobulin if indicated
NST
Complications of ECV? (5)
Short term FHR decel common complication post ECV
Less common:
* fracture of fetal leg bones,
* ROM,
* placental abruption,
* feto-maternal hemmorhage
How does IFHB work?
- Managed through Medavie Blue Cross (MBC)
- It’s a (seemingly) simple online or mailed form to sign up
- Works similarly to MSP
- Once approved you submit through MBC’s online platform for reimbursement
For people with refugee status
Does IFHB apply to newborns?
No, they are citizens so have MSP
What could Thalassemia look like on a CBC?
RBC N
Hb Low
MCV Low
MCH Low
Ferritin Normal high
What kind of disorder is thalassemia?
Autosomal recessive
Who more likely to be a carrier of thalassemia? (5)
Sub-Saharan African
Middle Eastern
Meditaranian
Indian
East/Southeast Asian
What is Bart’s disease?
4 /4 thalassemia genes – hydrops incompatible with life
What is the chance of 2 carriers of thalassemia having a babe with Bart’s disease?
25 %
What is sickle cell disease?
- Homozygous SS disease – autosomal recessive inherited disorder where hemoglobin S is produced instead of hemoglobin A. (1)
- Red blood cells (RBCs) form a moon/sickle shape making them less able to bend to travel through blood vessels, are more adhesive and more likely to clump together (1)
Sickle cell disease most common?
Black African American, but also Mediterranean, India, Middle East, sub-Saharan Africa
Sickle cell disease in pregnancy?
Maternal
* Raised metabolism (2)
* Higher hormones that raise risk of blood clots (2)
* Serious anemia (2)
* Increased pain crises (2)
* Increased risk of dying in pregnancy or postpartum (2)
* Higher risk of serious diseases caused by sickle cell disease (2)
* High blood pressure (2)
* Venous thromboembolism (2)
* Preeclampsia (2)
* UTIs (2)
Fetal
* Miscarriage (2)
* Preterm birth (2)
* Low birth weight (2)
* IUGR (2)
* Stillbirth (2)
Sickle cell train in pregnancy?
Usually asymptomatic:
Genetic counselling, increase incidence of UTIs, lessen accuracy of Hb A1C testing.
Offer urine culture every trimester.
