Columbus: Breech Flashcards
What is the incidence of breech delivery?
What are risk factors?
3–4%
Prematurity, fetal malformations, mullerian anomalies, polar placentation
What are contraindications for external cephalic version?
Breach firmly fixed in the pelvis Marked oligohydramnios Placenta previa Third trimester bleeding Prior uterine surgery except C-section Fetal distress
What is the success rate for ECV?
44%. Some studies range between 40 and 79%.
What is the protocol for external cephalic version?
OR on standby Ultrasound for position Ensure that breech is out of the pelvis NST Palpate uterus to determine contractile reactivity Front or back flip Check fetal heart rate when fetus is transverse NST at conclusion RhoGAM if indicated
What factors affect the chance of successful version?
Epidural, tocolysis, amount of amniotic fluid, size of fetus, location of placenta, size of mother, location of fetal back, parity
Why is cesarean section recommended for breech presentation?
Outlined by the Hanna study in Lancet 2000
Perinatal death is 4x greater with vaginal delivery
Serious perinatal morbidity is 3x greater with vaginal delivery
What are complications and their rates for external cephalic version?
Admission for observation 5% Reversion 3% Fetal distress 0.5% Emergency C-section 0.5% Fetal death 0.1%
What are contraindications to a trial of labor for breech?
Inexperienced operator
Deflection of fetal neck
EFW less then 1500 g or more than 4000 g
Footling (incomplete)
How does ACOG recommend delivery of twins if the first twin is breech?
What if the second twin is breech?
Cesarean section
Vaginal delivery is an option if both infants are greater than 1500 g
What factors improve the success of vaginal breech delivery?
Practice or simulation
Good anesthetic
Good assistant
Let the mother push until the umbilicus presents
Prepare forceps to deliver the after coming head
