Malpresentation

Question 1

When is the incidence of breech presentation highest?

Answer 1

28-34/40

Question 2

What are the three types of breech presentation?

Answer 2

Complete- both thighs and legs flexed
Frank- thigh flexed on abdomen and both legs extended at knee
Footling- one of both legs extended below the level of the buttock

Question 3

What are the fetal causes of breech?

Answer 3

Congenital anomalies e.g. Hydrocephalus 
Prematurity
Macrosomia
Multiple pregnancy
IUGR and IUFD

Question 4

What are the maternal causes of breech?

Answer 4

Pelvis abnormalities (tumours, contracted pelvis)
Abnormal placentation
Uterine abnormalities (fibroids, septate)
Multiparty
Poly/ oligo- hydramnios

Question 5

How is breech diagnosed?

Answer 5

Clinical exam- palpation and ballottment,
Pelvic exam
USS

Question 6

What are the three methods of vaginal breech delivery?

Answer 6

Spontaneous breech delivery
Assisted breech delivery (partial breech extraction)
Breech extraction (total)

Question 7

What is the mechanism of labour in a breech delivery?

Answer 7

A. Descent and engagement
B. Lateral flexion
C. Internal rotation
D. Flexion

Question 8

What are the four main methods of delivering the after-coming head?

Answer 8

Wigard-Martin’s
Mauriceau-Smellie-Veit’s
Burns-Marchall’s
Lovset’s

Question 9

What are the complications of breech delivery?

Answer 9

Birth asphyxia - cord prolapse and cord compression
Birth injuries (-fetus): brachial palsy, long bone fractures, tears in tentorium cerebelli, spinal cord disruptions

Question 10

What are the indications for C/S in breech?

Answer 10

EFW 3700g
Contracted pelvis
Footling breech
Deflexed head
Any other obstetric complication

Question 11

What is a compound presentation?

Answer 11

Prolapse of a fetal extremity into the lower uterine segment alongside the presenting part

Question 12

What causes a compound presentation?

Answer 12

An ill-fitting resenting part predisposes:
Prematurity
CPD
Multiple pregnancies
Polyhydramnios
Abnormal lie (transverse)

Question 13

How is compound presentation managed?

Answer 13

Confirm diagnosis
Establish fetal viability
If previable, allow vaginal delivery
If viable, outcome is better with C/S
Umbilical cord prolapse is a risk in compound presentation

Question 14

What is the prognosis for compound presentation?

Answer 14

25% perinatal mortality

Main causes- prematurity, cord prolapse, traumatic vaginal delivery

Question 15

What is breech presentation?

Answer 15

When fetal pelvis or lower extremities engages with the maternal pelvis