maternal medicine + postpartum problems.

Question 1

what are the risk factors for a breech baby? How is breech managed? What are the CI to managing breech?

Answer 1

• placenta previa, baby cannot position normally within the uterus
• twins
• Primip- firm uterine muscles/ Multip- lax muscles
• oligo/ polyhydramnios too little/ much fluid
• IUGR/ macrosomia
• prematurity
• uterine cavity abnormalities such as bicornate uterus/ uterine septum + fibroids
  ECV at 36/37 weeks. success ~ 30-60%, or delivery via c-section
  CI for ECV: multiple pregnancy, fetal distress/ abnormal CTG, recent antepartum bleed/ active vaginal bleeding, contraindications to vaginal birth, ruptured membranes, uterine abnormality, placenta praevia.
  Vaginal is possible with breech but increased risk of perinatal + neonatal mortality than c-section. (Term Breech Trial 2000)
  Flexed/ Extended can try for Vaginal but low-threshold to convert.
  ALL BREECH BABIES REQ 6/52 HIPS CHECK EVEN IF ECV

Question 2

What are the main types of breech position? What guides our management of Breech delivery?

Answer 2

Term Breech Trial 2000
Elective CS: Lower rates of perinatal + neonatal death + morbidity
lower risk of adverse perinatal outcomes
However, flawed trial bc:
- mixed multips + nulls together, no cohort division
- best outcome for baby but maternal outcomes not recorded
- did not record long-term morbidity

Types: Footling presentation, Extended, Flexed

Question 3

What are the risks of External Cephalic Version?

Answer 3

Premature Rupture of Membranes
Placental Abruption
Uterine Rupture
Umbilical Cord Entanglement

Question 4

What are the risks of Breech presentation? How is Breech managed in vaginal delivery?

Answer 4

4x risk of perinatal mortality due to Asphyxia
Abruption
Cord Compression
Entrapment of Head
Intracranial Haemorrhage
Don’t touch baby except manouverse Loveset’s to deliver arms, Mauriceau-Smellie- Veit to turn baby. If head stuck too long- Forceps.
CTG
Team: Cons Obs, Paed, Snr MW, Anaethetist, Scribe.

Question 5

What is anaemia defined as in pregnancy? Booking, Tri2-3, Postpartum?

Answer 5

<110g/l at Booking
<105 g/L Tri2-3
<100g/L postpartum

Question 6

what are the components of Postnatal Examination?

Answer 6

How is she? Any concerns?
Verbal consent, ensure privacy + safe env.
Supine for Palpate uterus + abdo inspect.
L lateral for exam of perineum
Obs: BP, temp, pulse, careful fluid balance to stop retention post-epidural
Breasts: Adequate lactation. Symptoms of mastitis?
Uterus: check involution + non-tender
Lochia: quantity, freq, odour, any clots?
Perineum + wound: integrity of wound
Legs: DVT, cellulitis
Urine: signs UTI, retention/ incontinence
Bowels: advice to avoid constipation
Diet “ rest