Malposition and malpresentation Flashcards
what is meant by Breech presentation
BREECH presentation
as opposed to cephalic presentation -where baby is bottom faced down and head is up
affects 3-5% of pregnancies (25% of baby are breech at 28)
RF- Matnernal -placenta (accreta, increta, percreta, accreta), uterine anmoramlity, multiparritiy, obstructed abdomen (fibroids)
Foetal-multiple gestations, premmaturity, foetal malformation, polyhydramnios, oiligohydramnios
3 types of breech-
Frank breech- bum down, legs straight up
Footling breech- One leg sticking out of uterus
Complete breech- legs are inside but folded-
Ix and Sx of Breech presentation
Sx-
abdo- Palpable head at fundus, soft breech in pelvis
Vaginal- soft presenting part, ichial tuberosity, anus or genitalia can be felt
footling breech- foot felt /seen through cervix
Ix- USS to confirm
Management of Antenatal and Term information for breech delivery
Antenatal (before term)- fetures suggestive of risky breech0
Hyperextended neck, high/low EFW, footling, foetal compromise
Term info-
Offer ECV (external cephalic version
50-60% sucess rate. can cause foetal distress needing emergency CS
If ECV unsucessful/declined- council
Benefits of CS- small reduces in mortality
Planned vaginal birth increase risk of low apgar and SHORT term complications
Risk of CS- smaall increase risk for mother
risk of complications for future preg
dont offer CS in 2nd stage of labour
Induction NOT reccomended
Continuous CTG
Delivering a breech baby
Very very bad if footling
“hand off approach”- ideally baby delivers self- if handling needed -thumb on sacrum and finger on ASIS
Pinnard Maneuvre- poke in politeal fossa which makes them bend their knee
if Baby head gets stuck- winging of scapuale
Rotate baby a transverse position and pull anterior down (lovesets maveuvre)
If head remains stuck- perform Mauricea-smellie-Veit– rest baby on forarm and pull head down
if not- forcepts
What is meant by unstable Lie (Sx, IX)
Neither cephalic or breech- needs to be repositioned in some way or cannot delivery
can be any position
Sx-
transverse- abdomen- no presenting part, uterus wide. Vaginal- no presenting part
Ix- US to confirm
Mx of unstable lie
Transverse Lie- ECV with 50% sucess, or CS
Brow- if persistent in 2nd stage of labour- CS
Face- mentoposterior CS. Mentoanterior -SVD
compound- manage expectantly
