Foetal presentations Flashcards
What is breech presentation?
Presenting part of fetus is the legs and bottom.
Occurs in less than 5% pregnancies by 37 weeks.
What is cephalic presentation?
Presenting of fetus is the head.
Occurs in most pregnancies by 37 weeks.
What are the 4 types of breech?
Complete
Incomplete
Extended (frank)
Footling
What is complete breech?
Legs fully flexed at hips and knees
What is incomplete breech?
One leg flexed at hip and extended at the knee
What is extended (frank) breech?
Both legs flexed at hip and extended at the knee
What is footling breech?
Foot presents through cervix with leg extended
What method is used to turn the fetus in breech presentation?
When is it used?
ECV (external cephalic version)
37 weeks+. (Before 36 weeks, babies turn spontaneously - so no action needed)
If ECV fails, what 2 delivery methods are available?
Vaginal delivery (with experienced midwife + obstetrician)
Elective C-section
When the first baby in a twin pregnancy is _____ presentation, C-section is required
Breech
What is the success rate for ECV?
50% success rate
What is the method used in ECV?
Fetus turned from breech -> cephalic using pressure on pregnant abdomen
What medication is given during ECV to make it easier?
Tocolysis with subcut terbutaline (beta-agonist) - reduces contractility of myometrium - makes it easier for baby to turn
When ECV is performed what blood test should be performed as a precaution in Rhesus-D negative women?
Kleihauer test
Also give anti-D prophylaxis based on the results of the above
What is puerperium?
Period of about 6 weeks after childbirth during which the mother’s reproductive organs return to their original non-pregnant condition.
What is transverse lie?
When the baby is lying across the abdomen (from side to side)
Why is amniotomy performed?
When is it performed
Artificial ROM so induces and strengthens labour contractions
Performed at 41 weeks
How is abnormal lie (transverse/oblique) managed?
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
What is oblique lie?
When the fetus lies with head in one iliac fossa (diagonally)
What circumstances can cause abnormal lie?
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
What does unstable lie in nulliparous woman represent?
Rare - signifies an obstruction somewhere!
What are the complications of unstable lie?
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
How is abnormal lie diagnosed?
Palpation of uterine fundus (head)
USS - shows fetal abnormality, pelvic tumour or placenta praevia and allows ECV to be performed
What monitoring is performed after ECV to ensure fetus is OK?
CTG
