fetal problems Flashcards
what is the leading cause of perinatal mortality and morbidity?
prematurity
what defines prematurity?
birth <37 + 6 weeks gestation
what are the reasons for elective premature delivery?
cervical incompetence APH amnionitis pyelonephritis diabetes polyhydramnios uterine abnormalities
what is a breech presentation?
this is when the fetal legs/bum is the presenting part
what are the types of breech position?
complete = bum is presenting and fetal legs are crossed (hips and knees flexed)
Frank = bum is presenting, hips flexed and knees extended, with legs in the air
footling = one leg up/crossed and one leg dangling down as the presenting part
which is the most common type of breech position?
frank
what are the uterine risk factors contributing to breech position?
multiparity
uterine septate/ malformations
uterine fibroids
placenta praevia
what are the fetal factors that contribute to breech position?
prematurity polyhydramnios macrosomia abnormalities e.g. ancephaly twins
what are the clinical features of breech lie in pregnancy? (
on abdominal palpation - feel fetal head higher up and irregular mass in pelvis.
fetal HR auscultated higher than normal
during deliver may notice signs of fetal distress e.g. meconium stained liquor
on vaginal examination, may feel scrotum/foot as presenting part
define an oblique lie
diagonal lie with head in one of the iliac fossas
define a transverse lie
across the uterus - shoulder is presenting part
define an unstable lie
fetal position changes from day to day
what type of fetal lie is the main risk for cord prolapse?
transverse
how is the lie of the baby confirmed?
USS
when should we start to consider management for breech babies?(weeks of gestation?
before 32-35 weeks it is not significant because most likely it will spontaneously correct itself and revert by term.
how is an abnormal lie of the fetus managed?
external cephalic version
how is an abnormal lie of the fetus managed?
external cephalic version
C section - if above is contraindicated, this is advised
vaginal breech birth
what are the complications of breech presentation?
associated with mortality and morbidity due to
major complication is cord prolapse asphyxia - secondary to delay in delvery prematurity congenital malformations fetal head entrapment premature rupture of membranes intracranial haemorrhage- due to head compression during delivery
what is ECV?
The manipulation of fetus within the uterus to a cephalic presentation through maternal abdomen.
what are the complications of ECV?
fetal bradycardia/ changes to heart rate - normally revert after
Also placental abruption
who is ECV more likely to work in?
multiparous women
polyhydramnios
when is ECV contraindicated?
placenta praevia previous C section uterine abnormalities ruptured membranes those with recent APH
when is a vaginal breech delivery contraindicated?
footling position - foot can slip through a non fully dilated cervix and head and shoulders can become trapped
how is a breech vaginal delivery performed?
Can deliver via the vagina but should not apply traction as this can lead to fetal head becoming trapped
if needed special manoeuvres can be performed