Unstable Lie & Breech

Question 1

Define unstable lie

Answer 1

Fetal lie and presentation persistently change from 37 weeks’ gestation

Question 2

What are the ‘‘5 M’’ risk factors for unstable lie/breech?

Answer 2

• Macrosomia
• Multiple gestations
• Multiparity
• Malformations (Uterus)
• preMaturity

Question 3

What are the ‘‘4 Ps’’ risk factors for unstable lie/breech?

Answer 3

Polyhydramnios
Pelvis - Android
Placental Previa
twin Pregnancy

Question 4

Complications of Unstable Lie

Answer 4

Cord prolapse
Fetal compromise

Question 5

How does management differ between Unstable lie and breech presentation

Answer 5

External Cephalic version only used in breech presentation

Question 6

Complications of Breech presentation

Answer 6

Vaginal birth hypoxia/trauma
Prematurity
Increased incidence of congenital malformations
Cord prolapse if ROM
ICH

Question 7

Different types of breech presentation

Answer 7

Complete - Both legs Flexed at the hip
Frank - Flexed at the hip + extended at the knee
Footling

Question 8

When and why to implement ECV?

Answer 8

36/40 onwards.
Prevents ECS

Question 9

Why would one want to avoid CS?

Answer 9

Increased risk of repeat CS
Scar dehiscence
Placenta accreta
Hysterectomy risk
PPH

Question 10

Risk of ECV

Answer 10

Cord entanglement
Placental abruption
APH
Fetal distress
ECS (1/200)

Question 11

Contraindications of ECV

Answer 11

APH
PROM
Uterine abnormality
Prev. CS
abN CTG
Twins
Placental Previa

Question 12

What to advise mothers who have had ECV to safety net them?

Answer 12

If RFM, bleeding or pain - return to hosp

Question 13

Mgx of Breech

Answer 13

1) ECV
2) Vaginal breech delivery (high perinatal mortality)
3) ELCS (39/40 for primip)