Malpresentation Flashcards
What % of babies are breech at 20 weeks?
40%
What are the causes and associations os breech presentation?
idiopathic uterine abnormalities fibroids prematurity placenta praevia oligohydramnios fetal abnormalities
What are the 3 types of breech
- Extended - flexed at the hips, extended at the knees
- Flexed - knees and hips flexed - presenting part is mix of buttocks, external genitalia and feet
- Footling breeches - greatest risk of cord prolapse
how is a diagnosis of breech made
→ Examination - pain under ribs, longitudinal lie, smooth round mass at fundus
→ US
What is the main management of breech
when is it indicated
what is success rate in first babies
external cephalic version
→ Needed if vaginal delivery planned after 36-37 weeks
40% success
wHat are CIs of ECV
- Placenta praevia
- Multiple pregnancy
- APH in last 7 days
- Ruptured membranes
- IUGR
- Abnormal CTG
- Uterine scars
- Fetal abnormality
- Pre-eclampsia or HTN
what is a risk of vaginal birth w a breech baby
increased risk of hypoxia and birth trauma
what are CI of vaginal birth w breech
footling/kneeling breech, estimated fetal weight >3800 or <2000, prev. LSCS, hyperextended fetal neck
What is the main management of breech delivery
CS
Why does occipitoposterior position cause prolonged labour
due to extra rotation needed
How is OP diagnosed
Antenatally w palpation
Vaginal examination - posterior fontanelle found to lie in the posterior quadrant of the pelvis
How are OPs delivered?
- 73% vaginal
- 22% forceps
- 5% CS
How do most face presentations engage?
transversely
when is CS indicated in face presentation?
If the chin rotates to the sacrum then CS
what method of delivery is CI in face presentation
ventouse
how do face presentation babies end up being born vaginally
Most then rotate so that the chin lies behind the symphysis and the head can be born by flexion
What is the management of brow presentation ?
expectant, LSCS if slow or brow presentation persists
How is transverse lie diagnosed? i.e what signs are there
→ 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
What does transverse lie confer a high risk to
cord prolapse
What is the management of transverse lie
If malpresentation persists or ECV at 37 weeks fails, CS
