Malpresentation

Question 1

What % of babies are breech at 20 weeks?

Answer 1

40%

Question 2

What are the causes and associations os breech presentation?

Answer 2

idiopathic
uterine abnormalities
fibroids
prematurity
placenta praevia
oligohydramnios
fetal abnormalities

Question 3

What are the 3 types of breech

Answer 3

1. Extended - flexed at the hips, extended at the knees
2. Flexed - knees and hips flexed - presenting part is mix of buttocks, external genitalia and feet
3. Footling breeches - greatest risk of cord prolapse

Question 4

how is a diagnosis of breech made

Answer 4

→ Examination - pain under ribs, longitudinal lie, smooth round mass at fundus
→ US

Question 5

What is the main management of breech
when is it indicated
what is success rate in first babies

Answer 5

external cephalic version
→ Needed if vaginal delivery planned after 36-37 weeks
40% success

Question 6

wHat are CIs of ECV

Answer 6

• Placenta praevia
• Multiple pregnancy
• APH in last 7 days
• Ruptured membranes
• IUGR
• Abnormal CTG
• Uterine scars
• Fetal abnormality
• Pre-eclampsia or HTN

Question 7

what is a risk of vaginal birth w a breech baby

Answer 7

increased risk of hypoxia and birth trauma

Question 8

what are CI of vaginal birth w breech

Answer 8

footling/kneeling breech, estimated fetal weight >3800 or <2000, prev. LSCS, hyperextended fetal neck

Question 9

What is the main management of breech delivery

Answer 9

CS

Question 10

Why does occipitoposterior position cause prolonged labour

Answer 10

due to extra rotation needed

Question 11

How is OP diagnosed

Answer 11

Antenatally w palpation

Vaginal examination - posterior fontanelle found to lie in the posterior quadrant of the pelvis

Question 12

How are OPs delivered?

Answer 12

• 73% vaginal
• 22% forceps
• 5% CS

Question 13

How do most face presentations engage?

Answer 13

transversely

Question 14

when is CS indicated in face presentation?

Answer 14

If the chin rotates to the sacrum then CS

Question 15

what method of delivery is CI in face presentation

Answer 15

ventouse

Question 16

how do face presentation babies end up being born vaginally

Answer 16

Most then rotate so that the chin lies behind the symphysis and the head can be born by flexion

Question 17

What is the management of brow presentation ?

Answer 17

expectant, LSCS if slow or brow presentation persists

Question 18

How is transverse lie diagnosed? i.e what signs are there

Answer 18

→	Ovoid uterus wider at the side
→	Lower pole empty
→	Head lies in one flank
→	Fetal heard in variable positions
→	No features found on vaginal examination

Question 19

What does transverse lie confer a high risk to

Answer 19

cord prolapse

Question 20

What is the management of transverse lie

Answer 20

If malpresentation persists or ECV at 37 weeks fails, CS