Malpresentation/Malposition Flashcards
What are risk factors of breech presentation?
Idiopathic Uterine abnormalities - bicornate uterus, fibroids Prematurity Placenta praevia Oligohydramnios Fetal abnormalities e.g. hydrocephalus
What is extended breech presentation?
Frank breech
Flexed at the hips but extended at the knees
What is flexed breech?
Hips and knees both bleed so that the presenting part is a mixture of buttocks, external genitalia and feet
What is a footling breech? Risk?
One or both feet come first with the bottom at a higher position
Greater risk of cord prolapse
How is breech presentation diagnosed?
On palpation, the lie is longitudinal
No head is felt in the pelvis
In the fundus there is a smooth round mass which can be ballotted
Diagnosis made by US
What is management of breech presentation?
If < 36 weeks, many foetuses will turn spontaneously
If still breech at 36 weeks - external cephalic version (ECV)
If still breech, planned C-section or vaginal delivery
What is external cephalic version?
Turning the breech by manoeuvring it through a somersault
36-37 weeks
What are contraindications to external cephalic version?
Placenta praevia Multiple pregnancy Abnormal CTG Mothers with uterine scars, uterine abnormality Ruptured membranes Antepartum haemorrhage within last 7 days Fetal abnormality Pre-eclampsia or hypertension
What are contraindications to vaginal delivery of breech?
Inexperienced clinician Footling or kneeling breech Estimated fetal weight > 3800 or < 2000g Previous lower segment C-section Hyperextended fetal neck
What technique for vaginal breech delivery
Hands off
Baby is not touched by birth attendant until scapulae are visible
Encourage baby to remain so spine is anterior
Once scapulae are visible, hook the arms at the elbow
If arms are not visible, route the body in each direction to allow delivery of the arms
Allow bode to hang and once the nape of the neck is visible, place two fingers of the right hand over the maxilla and two fingers of the left hand over the occiput to flex the head.
If this fails, use forceps
Neonatal doctos should be preesent
What should you check the baby for after breech vaginal delivery?
Hip dislocation at both and by US at 6 weeks
Klumpke’s palsy
Signs of CNS injury
What is occipitoposterior position? Management?
Posterior fontanelle found to lie in posterior quadrant of pelvis
Labour prolonged due to rotation required
Vaginal delivery, forceps of C-section
What is face presentation? Cause?
Extended head in engagement
Anaencaphaly
Tumour of or shortened fetal neck msucles
Management of face presentation
If chin rotates to the sacrum, caesarian section indicated
Ventouse is contraindicated but forceps delivery is possible if head is well below the spines
What is brow presentation? Management?
Head is between full flexion and full extension and may revert to either
If it persists, vain gal delivery is not possible
Expectant management, C-section if it persists
