Fetal Malpresentation

Question 1

Types of Breech

Answer 1

1.Frank (Extended)
2.Complete (Flexed)
3.Footling

Question 2

Maternal Predisposing factors for Breech

Answer 2

FIbroids
Congenital Uterus Abnormalities
Uterine Surgery

Question 3

Fetal/Placental Predisposing Factors for Breech

Answer 3

Multi. Preg
Premature
Poly/Oligo hydramnios
Placenta Previa
Anencephaly
Hydranencephaly
Fetal Neuromuscular condition

Question 4

External Cephalic version should be done no earlier than

Answer 4

37 weeks

Question 5

What type of drug can be given to increase the success rate of ECV

Answer 5

Tocolytic (Nifedipine)

Question 6

What precautions should be taken?

Answer 6

CTG should be done before and after procedure
Anti-D should be given if Rh -ve mother

Question 7

Method of ECV

Answer 7

1.Woman lies flat w/ left lateral tilt
2.Ensure comfort +empty bladder
3. Use U/S guide
4.Elevate fetus from pelvis, one hand manipulates body upward and forward. other hand gently flexes baby head and brings down to pelvis

Procedure should be no longer than 10 mins. If too difficult or fail= abandon

Question 8

Contraindications of ECV

Answer 8

Fetal Abnormalities
Placenta Previa
History of antepartum Haemorrhage
Multi. Preg
Prev CS
Pre-eclampsia/Hypertension
Oligo/Poly hydramnios
Plan to have CS

Question 9

Risks of ECV

Answer 9

Placental Abruption
PROM
Cord Accident
Fetal Bradycardia
Transplacental Haemorrhage

Question 10

Breech Vaginal Delivery Prerequisites

Answer 10

Frank or Complete Breech
No fetal abnormalities
No fetal-pelvic disproportion
No hyperextension of fetal head

Question 11

Labour Management

Answer 11

Monitor fetal wellbeing
Epidural
Fetal Blood Sampling

Question 12

Technique of Vaginal Delivery of Breech

Answer 12

1.Delivery of Buttocks
2.Delivery of lower limbs (Pinnards manoeuvre if extended legs)
3.Delivery of Shoulders(Loveset Manoeuvre)
4.Delivery of Head (Maurice-Smell-Veit manoeuvre)