Malpresentations

Question 1

How does OP labour differ

Answer 1

Back pain

1 hour longer in multips

2 hours longer in primips

Maybe more tears

Question 2

What are the options for delivery of an OP baby?

Answer 2

Spontansouns vaginal birth

Manual rotation - flex head and during a contraction the head will hopefully turn

Vacuum extraction - put in midline

Forceps - may slip off head as deisgned for OA babies

Rotational forceps - kielland

CS always back up

Question 3

Which is the most common breech

Answer 3

Most common breech - frank. Legs up in the air

Then complete

Then footling

Question 4

RF for breech

Answer 4

uterine abnormalities
Polyhydramnios
Oligohydramnios
Pre-term
Twins
High parity
Macrosomia
Placenta previa

If breech diagnosed - NEEDS FORMAL USS WITH ANATOMY

Question 5

Describe the breech delivery

Answer 5

the rump delivers with a hands off approach. The hips will rotate to an AP position
The baby then rotates so the spine is anterior

You may need to be hands on to prevent the back from rotating to posterior.

Then you may ened to release the arms (you dont want them to be nuchal)
Flex at the elbow and that should help the release. You may need to do Lovset’s manouever which involves rotating baby to right and left - not if any resistance.

10-20% breech deliveries require assistance.

Delivery the baby if it is extended via the MSV - dominant hand on baby’s belly and on chin to flex and the non dominant middle finger on the baby’s occiput

Question 6

What are the complicating factors of a breech delivery

Answer 6

Cervix might be too tight - try push cervix over head but might require the cutting of the cervix using 3 pairs forceps

Might need forceps if MSV manouever dosnt work. ALWAYS APPLY TO MATERNAL LEFT FIRST

Question 7

Why do you keep your hands off the breech

Answer 7

Because if the bitrochanteric diamete delivers sponteously, so will the flexed head

Question 8

WHAT TO DO IF UNEXPECTED BREECH COMES IN IN LABOUR

Answer 8

Keep room calm

keep hands off the breech

Get synto up in case contractions need help

Ensure back stays under the symphsis

Birth of the breech to the scaular should happen within 3 minutes

Spontaneous birth of shoulders unless arm is stuck

For head - hand forceps ready, ensure good contractions
Do MSV manouever with suprapubic pressure if need

Question 9

Factors pre-disposing to face presentations

Answer 9

Multiparous woman
neck problems e.g. goitre
Big baby and contraceted pelvis

Question 10

Which face presentation can be delivered vaginally and why

Answer 10

Mentum anterior position

Because the head can then flex to be born

Question 11

What to do with a brow presentation

Answer 11

Usually unstable. If converts to vertex or face then may be deliverable vaginally. If does not convert. For CS.

Question 12

What are the 2 ways that cord prolapse can present after SROM/ARM

Answer 12

Cord prolapse because presenting part is not occlusing outlet - polyhydrmanios/high presenting part/footling breech

Occult cord prolapse - already cord was coiled against presenting part and is just revealed by the ARM/SROM

Question 13

What type of breech is cord prolapse most common in

Answer 13

footling breech

Question 14

What is the management of a prolapsed umbilical cord

Answer 14

1. Diagnosed the prolapsed cord by examination
2. CTG
3. Assess dilatation/ability to delivery int he room
4. Prepare the woman for immediate CS if not deliverable - put woman on all 4s with bum in air or left lateral with trendelenbergs, fill bladder with 500-700ml warmed saline, ensure cord stays in vagina. Tocolyse if she is in labour
5. Dont attempt to put cord back in uterus
6. If delay - wrap cord with warm wet packs