OBN: Breech Delivery

Question 1

Determine the presentation: hips flexed, knees extended

Answer 1

Frank breech

Question 2

Determine the presentation: hips flexed, knees flexed

Answer 2

complete breech

Question 3

___% risk of breech delivery if second breech

Answer 3

10%

Question 4

___ % risk of breech delivery if third breech

Answer 4

27%

Question 5

___ trial states that planned cesarean delivery was associated with lower risk of perinatal mortality and lower risk of “serious” neonatal morbidity

Answer 5

Hannah Trial (2000)

Question 6

___% risk of cord prolapse in footling presentation

Answer 6

15% - do CS

Question 7

___% risk of cord prolapse in complete breech

Answer 7

5% - do CS

Question 8

___% risk of cord prolapse in frank breech

Answer 8

0.5% - Vaginal deliver

Question 9

____ maneuver in the delivery of the aftercoming head when two fingers of one hand grasping the shoulders of the back-down fetus from below while the other hand draws the feet up and over the maternal abdomen

Answer 9

Modified Prague

Question 10

___ maneuver in the delivery of the aftercoming head when the index and middle finger of one hand are applied over the maxilla, to flex the head, while the fetal body rests on the palm of the hand and forearm. The assistant gives gentle suprapubic pressure to keep the head flexed.

Answer 10

Mariceau

Question 11

___ refers to the maneuver where the nuchal arm is reduced to deliver a breech baby

Answer 11

Loveset maneuver

Question 12

What are the criteria for planned vaginal breech delivery?

Answer 12

1. Skilled OB
2. Facilities for possible CS available
3. Woman is informed of risk
4. EFT 2500 to 4000 grams
5. Continuous EFM
6. Induction is NOT recommended
7. Passive 2nd stage without active pushing for 90 minutes allowing breech to descend into pelvis
8. breech delivery not more than 60 mins. or else, deliver via CS

Question 13

[Cardinal Movements: Breech]

In engagement and descent,

Answer 13

Bitrochanteric diameter in oblique diameter

Question 14

[Cardinal Movements: Breech]

___ degree of hip rotation during internal rotation

Answer 14

45 degree rotation

Anterior hip toward pubic arch

Bitrochangeric diameter in AP diameter of outlet

Question 15

[Cardinal Movements: Breech]

posterior hip over the perineum

Answer 15

Lateral flexion

Question 16

[Cardinal Movements: Breech]

fetal back turns anteriorly

Answer 16

External rotation

Question 17

[Cardinal Movements: Breech]

bisacromial diameter in AP plane

Answer 17

Internal rotation

Question 18

[Cardinal Movements: Breech]

posterior neck under symphysis pubis, head born in flexion

Answer 18

Expulsion

Question 19

[Cardinal Movements: Breech]

What are the steps?

Answer 19

1. Engagement
2. Descent
3. Internal Rotation
4. Lateral flexion
5. External rotation
6. Internal rotation
7. Expulsion

Question 20

What is the goal of breech decomposition?

Answer 20

Bring fetal feet within reach

Question 21

___ maneuver used in frank breech delivery

Answer 21

Pinard Maneuver

Question 22

[Breech delivery]

Arms shall be delivered if this anatomic part is seen

Answer 22

Scapula

Rotate arm to anterior = loveset maneuver = reduce nuchal arms

Question 23

[Breech delivery]

___ maneuver to deliver the aftercoming head

Answer 23

Mauriceau-Smellie-Veit Maneuver

Question 24

___ forceps used to deliver the aftercoming head

Answer 24

piper forceps

Question 25

[Breech delivery]

Symphysiotomy iwdens the symphysis pubis by up to ____

Answer 25

2.5cm