ECV and Breech Flashcards
Overall succes rate for ECV
Primip and nullip
Overall 50%
P0 40%
Multip 60%
Reversion back to breech post ecv
3-5%
After ECV chance of LSCS
Increased
Which agents can be used for tocolysis?
Salbutamol/ terbutaline
What are contraindications for tocolysis?
BBlockers
Palpitations
Cardiac disease/HTN
What are side effects of tocolysis?
Tachycardia, flushing, tremor and occasional nausea
When should ECV be offered?
37 weeks- multip
36 P0
Absolute contraindications to ECV
4
Abruption PET- severe Abnormal fetal dopplers Abnormal CTG SROM
Relative contraindications
Scarred uterus
Unstable lie
IUGR
Oligohydramnios
Risk of EMCS after ecv
0.5% within 24 hours
Should anti d be given?
Yes within 72 hours
What is the recurrence rate of breech presentation?
9.9%
What percentage of term deliveries are breech?
3-4%
All term breech babies have increased risk of poor outcome
Planned ceasarean section have slightly decreased risk neonatal mortality 0.5/1000
What is the perinatal mortality for planned vaginal breech and cephalic breech?
Breech 2/1000
Babies have increased risk of low apgar scores but no increased risk long term morbidity
Cephalic 1/1000
What can reduced risk with ELCS also be attributed to?
< risk stillbirth
Avoidance of IP risks
In breech pregnancy, when should caesarean be reccommended?
Presence of any other RFs
Independent risk factors for poor outcome vaginal breech delivery?
Hyperextended neck on uss EFW >3.8kgs EFW <10th centile Footling Evidence of antenatal compromise
Can yon induce breech delivery?
No
If augmentation required- use synto
Preterm breech
22-25+6- LSCS not recommended
If PT delivery due to maternal/ fetal compromise- LSCS is recommeded
Lovset
Twisting
Mariceau-Smellie-Viet
Flex head down
Bracht
Grasp body with knes flexed and bring up to symphysis pubis
