Foetal presentations

Question 1

What is breech presentation?

Answer 1

Presenting part of fetus is the legs and bottom.

Occurs in less than 5% pregnancies by 37 weeks.

Question 2

What is cephalic presentation?

Answer 2

Presenting of fetus is the head.

Occurs in most pregnancies by 37 weeks.

Question 3

What are the 4 types of breech?

Answer 3

Complete
Incomplete
Extended (frank)
Footling

Question 4

What is complete breech?

Answer 4

Legs fully flexed at hips and knees

Question 5

What is incomplete breech?

Answer 5

One leg flexed at hip and extended at the knee

Question 6

What is extended (frank) breech?

Answer 6

Both legs flexed at hip and extended at the knee

Question 7

What is footling breech?

Answer 7

Foot presents through cervix with leg extended

Question 8

What method is used to turn the fetus in breech presentation?

When is it used?

Answer 8

ECV (external cephalic version)

37 weeks+. (Before 36 weeks, babies turn spontaneously - so no action needed)

Question 9

If ECV fails, what 2 delivery methods are available?

Answer 9

Vaginal delivery (with experienced midwife + obstetrician)

Elective C-section

Question 10

When the first baby in a twin pregnancy is _____ presentation, C-section is required

Answer 10

Breech

Question 11

What is the success rate for ECV?

Answer 11

50% success rate

Question 12

What is the method used in ECV?

Answer 12

Fetus turned from breech -> cephalic using pressure on pregnant abdomen

Question 13

What medication is given during ECV to make it easier?

Answer 13

Tocolysis with subcut terbutaline (beta-agonist) - reduces contractility of myometrium - makes it easier for baby to turn

Question 14

When ECV is performed what blood test should be performed as a precaution in Rhesus-D negative women?

Answer 14

Kleihauer test

Also give anti-D prophylaxis based on the results of the above

Question 15

What is puerperium?

Answer 15

Period of about 6 weeks after childbirth during which the mother’s reproductive organs return to their original non-pregnant condition.

Question 16

What is transverse lie?

Answer 16

When the baby is lying across the abdomen (from side to side)

Question 17

Why is amniotomy performed?

When is it performed

Answer 17

Artificial ROM so induces and strengthens labour contractions

Performed at 41 weeks

Question 18

How is abnormal lie (transverse/oblique) managed?

Answer 18

NAD <37 weeks
37 weeks+ admit to hospital in case of ROM. USS to exclude polyhydramnios and placenta praevia

ECV unjustified as foetus usually turns back

If constant abnormal lie, C-section delivery or expert ECV + amniotomy

Question 19

What is oblique lie?

Answer 19

When the fetus lies with head in one iliac fossa (diagonally)

Question 20

What circumstances can cause abnormal lie?

Answer 20

Conditions allowing more room to turn:

• Polyhydramnios
• High parity (more lax uterus)

Conditions preventing turning:

• fetal/uterine abnormalities
• twin pregnancies

Conditions preventing engagement:

• placenta praevia
• pelvic tumours
• uterine deformity

Prematurity also risk factor

Question 21

What does unstable lie in nulliparous woman represent?

Answer 21

Rare - signifies an obstruction somewhere!

Question 22

What are the complications of unstable lie?

Answer 22

Unable to deliver vaginally

Arm/umbilical cord prolapse when membranes rupture

Obstruction can cause uterine rupture

Long-term neuro handicap for baby

Labour - hypoxia/birth trauma risks

Mother+foetus at risk

Question 23

How is abnormal lie diagnosed?

Answer 23

Palpation of uterine fundus (head)

USS - shows fetal abnormality, pelvic tumour or placenta praevia and allows ECV to be performed

Question 24

What monitoring is performed after ECV to ensure fetus is OK?

Answer 24

CTG