Malpresentation

Question 1

Mention CI and CCC of ECV

Answer 1

CCC: fetomaternal Hge, fetal distress and shock, placental separation, PTL, PPROM, cord prolapse and knotting, rupture uterus or veins in broad igament
CI: APhge, HTN, multiple pregnancy, CMF of fetus, CMF of uterus, previous uterine scar, indication of CS.

Question 2

Mention causes that make Rt oblique diameter more favorable for AP diameter than Lt

Answer 2

1. Presence of sigmoid colon in left side
2. Right hip is used more so right iliopectineal eminence is pushed to the inside
3. Uterus is dextrorotated dextropositioned

Question 3

Mention factors that cause deflexion during engagement in occiput posterior malposition

Answer 3

1. BTD passes easily while BPD passes with difficulty from sacrocoteloid diameter, so forehead passes while occiput arresrs
2. Convexty of maternal and fetal backs meets causing straining of fetal back
3. Early ROM inc straightening of fetal spine

Question 4

Mention causes of fetal mortality and morbidity in breech malpresentation

Answer 4

MT: intracranial hemorrhage, rupture of internal organs, fracture dislocation of cervical spines, asphyxia.
MB: joint dislocation, bone fractures, sternomastoid rupture, trauma to external genitalia

Question 5

Mention criteria of optimal selection in TOL for vaginal delivery

Answer 5

1. Spontaneous onset of labour
2. No indication for CS or previous CS
3. Fetus not less than 2000 gm not more than 4000 gm
4. Head is not hyperexteded
5. Frank or complete breech
6. Well-trainedstaff on breech delivery
7. GA 36 wk or more

Question 6

Mention indications of breech extraction

Answer 6

1. Breech during CS
2. Delivery of retained 2nd twin
3. Urgent VD (e.g. prolapsed cord)
4. Multiparous mother (wide pelvis) and small fetus