GTG breech / GTG assisted vaginal birth

Question 1

In breech presentation, does planned CS reduce perinatal mortality?

Answer 1

Small reduction
0.5/1000 with CS
1.0/1000 planned cephalic birth
2.0/1000 planned breech birth

Question 2

Proportion of women planning vaginal breech del that require EMCS

Answer 2

40%

Question 3

Factors which make a vaginal breech delivery high risk

Answer 3

Hyperextended neck on USS
>3.8kg
<10th centile EFC
Footling presentation
AN compromise

Question 4

Is induction appropriate in breech presentation?

Answer 4

Not recommended
BUT if spontaneous labour with epidural and inadequate contractions, can give oxytocin augmentation

Question 5

Contraindications to assisted vaginal birth?

Answer 5

Fetal bleeding disorders or predisposition to fractures
Vacuum extraction <32 weeks due to risk of subgaleal haemorrhage (use with caution 32-36w)

Question 6

When is fetal scalp electrode contraindicated?

Answer 6

HIV hepatitis
Maternal bleeding disorders e.g ITP
Fetal bleeding disorders e.g. haemophilia
Prematurity <34w

Question 7

In what cases should you reassess during vacuum assisted delivery?

Answer 7

2 pop offs
2 pulls - no descent
If less experienced, should seek help after 1 pop off/1 pull no descent

Question 8

What is the use of sequential instruments associated with?

Answer 8

Increased risk of injury to fetus
Increased risk of OASI

Question 9

When should you consider a trial in theatre?

Answer 9

Head is 1/5th palpable
Head is in mid-pelvis
Rotation required
Concern re: cephalo-pelvic disproportion