Malpresentation Flashcards
How do you assess presentation?
Abdominal Exam
US
What do you look for on US in breach?
Heart beat
Amniotic fluid index
Movements
Placental position
What percentage of babies are breach at 36 weeks? What are the chances of spontaneous return to cephalic?
5%
50%
What are the causes of breach?
Placenta previa Uterine masses pressing Bicornuate uterus Oligo/polyhydramnios Multiple pregnancy Fetal abnormalities
How do you manage a breach?
Watch and wait for spontaneous change
External cephalic version
Trial of vaginal delivery
Caesarean
What is an external cephalic version?
Pushing on the abdomen to try to turn the baby around
When do a external cephalic version?
After 37 weeks as it can cause delivery to occur
How are ECV done?
In pregnancy daycare clinic
US to check position and volume of amniotic fluid and position of cord - in case of cord strangulation
Can give terbutaline to relax uterine
Apply external force to the fetus
Why US in ECVs?
Kind of breach
Fluid level
Fetal health
Cord position and placenta position
What are the risks of ECV?
Won’t work
Fetal distress with cord entanglement
Pain for woman
Rupture of membranes or placental abruption
Why are paediatricians present for breach caesars?
To check hips for developmental dysplasia of the hips
- US is performed as well
What must be done for a vaginal breach delivery?
Continuous fetal monitoring
Explanation of risk
Check type of breach
Must make good progress
What are grand multiparous more at risk of in the third stage?
PPH due to uterine atony
What is the rotation maneuver called
Loveset
What is it called when the arms are parallel to the head?
Nuchal arms
