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VAGINAL BREECH DELIVERY Flashcards

1
Q

Define breech presentation

A

Breech presentation occurs when the fetus lies longitudinally with the buttocks presenting in the lower pole of the uterus

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2
Q

the most common form of malpresentation in pregnancy

A

breech presentation

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2
Q

Percentage of breech at term

A

3 - 4%

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3
Q

Percentage of breech with premature delivery

A

25%

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4
Q

Flexed hips, extended knees bilaterally

A

FRANK (EXTENDED BREECH)

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5
Q

Both hips / knees flexed

A

COMPLETE BREECH

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6
Q

Describe FOOTLING BREECH

A

One (single footling, breech) or both (double footling breech) legs extend below level of buttocks

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7
Q

Another name for frank breech

A

Extended breech
Flexed hips, extended knees bilaterally

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8
Q

Another name for complete breech

A

Flexed breech
Both hips / knees flexed

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9
Q

5 fetal causes of breech presentation

A
  1. Prematurity
  2. Fetal malformations
    –Hydrocephalus/anencephaly
  3. Polar placentation
    –Cornual
    –Praevia
  4. Genetic disorders (causing fetal hypotonia)
    –Trisomies 13, 18, 21
    –Potter syndrome
    –Myotonic dystrophy
  5. Abnormalities of liquor volume
    –Polyhydramnios
    –Oligohydramnios
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10
Q

4 maternal causes of breech presentation

A
  1. Pelvic tumours
  2. Uterine anomalies (recurrent breech presentation)
    – Bicornuate/septate uterus
  3. Contracted pelvis
  4. High parity
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11
Q

3 clinical examinations for the diagnosis of breech presentation

A
  1. Leopold’s manouvre
    —Firm, rounded fetal head
    ballotable in fundus
  2. Fetal heart audible above
    umbilicus
  3. Pelvic examination
    —Soft irregular breech
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12
Q

ULTRASOUND CONFIRMS DIAGNOSIS AND EXCLUDES:

A

Placenta praevia
Multiple pregnancy
Skeletal abnormalities
Hydrocephalus
Spina bifida
Fetal ascites
Abdominal tumours

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13
Q

T/F: Ultrasound Scan confirms degree of extension/flexion of fetal head

A

T

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14
Q

T/F: X-ray can be used in the diagnosis of breech in the absence of USS

A

T

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15
Q

Antepartum management of breech involves – and –

A

Anticipate spontaneous version

Counsel on risks of delivery options

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16
Q

3 modalities of breech management

A

External cephalic version

Elective caesarean section

Planned vaginal delivery

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17
Q

ECV is employed for – and –

A

Singleton breech

Non-vertex second twin

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18
Q

At what GA is ECV performed

A

36 - 37 weeks

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19
Q

5 Requirements for ECV

A
  1. Ultrasound
    2 Cardiotocographic monitoring
  2. Tocolysis (controversial)
  3. Regional Anesthesia—optional
  4. Facilities for caesarean section
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20
Q

Mean success rate of ECV

A

60%

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21
Q

T/F: Higher success of ECV in Africans

A

T

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22
Q

Success rate of ECV

A

35 – 85%

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23
Q

6 Factors Associated with failure of ECV

A

Obesity
Engagement of the breech
Oligohydramnios
Posterior positioning of fetal back
Fibroids
Congenital uterine anomalies

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24
Q

8 Complications of ECV

A

Feto – maternal transfusion
Placental abruption
Uterine rupture
Cord accident
Amniotic fluid embolism
Preterm labour/rupture of membranes
Fetal distress
Fetal demise

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25
Q

3 risks of vaginal breech delivery compared with cephalic delivery

A

Cord compression/prolapse
Difficulty in delivering shoulders
Difficulty in delivering the head

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26
Q

9 antepartum criteria for vaginal breech delivery

A
  1. Frank breech presentation
  2. Gestational age ≥ 34 weeks
  3. Estimated fetal weight of 2000 –
    3500g
  4. Flexed fetal head
  5. Normal clinical/radiological
    pelvimetry
    –Inlet: Transverse
    11.5cm/AP10.5cm
    – Cavity: Transverse
    10.0cm/AP 11.5cm
  6. No indication for caesarean
    section
  7. Previable fetus
  8. Congenital anomaly
  9. Presentation in advanced labour
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27
Q

For vaginal breech delivery GA should be

A

≥ 34 weeks

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28
Q

For planned vaginal breech delivery the EFW should be

A

2000 – 3500g

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29
Q

For planned vaginal breech delivery the transverse and AP diameter of the pelvic inlet should be

A

Transverse 11.5cm/AP10.5cm

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30
Q

For planned vaginal breech delivery the transverse and AP diameter of the pelvic cavity should be

A

Transverse 10.0cm/AP 11.5cm

31
Q

For planned vaginal breech delivery the type of breech should be

A

Frank breech presentation

32
Q

T/F: The fetal head should be flexed for planned vaginal breech delivery

33
Q

9 aspects of intrapartum management of breech vaginal delivery

A
  1. Normal progression first/second
    stage
  2. Avoidance of
    induction/augmentation
  3. Avoidance of breech extraction
  4. Continuous electronic fetal
    monitoring
  5. Policy of non-interference until
    spontaneous delivery of breech
    up to the umbilicus
  6. Early recourse to caesarean
    section
  7. Theatre must be available
  8. Anesthesia must be available
  9. Informed consent
34
Q

In the intrapartum management of vaginal breech delivery, there should be Policy of non-interference until

A

spontaneous delivery of breech up to the umbilicus

35
Q

9 indications for CS with breech presentation

A
  1. If the Estimated Fetal Weight is
    < 1.5KG OR > 3.5kg
  2. Contracted or Borderline
    Maternal Pelvis
  3. Prolonged rupture of
    membranes
  4. Footling Breech
  5. Unengaged presenting part
  6. PRIMIGRAVIDA
  7. Hyperextended head
  8. Poor obstetric history
  9. Any other routine indication for
    CAESAREAN DELIVERY
36
Q

EFW for CS in breech presentation

A

</= 1.5KG OR >/= 3.5kg

37
Q

3 methods of vaginal breech delivery

A

Spontaneous breech delivery
Assisted breech delivery
Breech extraction

38
Q

Spontaneous Breech Delivery is

A

Delivery without assistance or obstetric manoeuvres to the baby’s body

39
Q

Assisted Breech Delivery involves

A

The fetal body being guided through the birth canal by a series of properly-timed manoeuvres to deliver various parts of the body safely, taking advantage of maternal expulsive efforts

40
Q

Breech Extraction involves

A

The whole of the fetal body being extracted by the accoucheur without the assistance of maternal efforts

41
Q

When is Zatuchni Andros scoring system used in vaginal breech delivery

A

if unbooked or if the Breech Presentation is just being diagnosed in labour

42
Q

T/F: The assessment of Zatuchni Andros score is designed to be made at the onset of labour

43
Q

The 6 indices assessed in the Zatuchni Andros prognostic score are

A
  1. Parity
  2. Previous vaginal breech delivery
    (baby >2.5kg)
  3. Gestational age
  4. Estimated fetal weight
  5. Cervical dilatation
  6. Station
44
Q

The highest possible score in Zatuchni scoring system is

45
Q

The highest point for any one criteria in the zatuchni scoring system is

46
Q

The lowest point for any one criteria in the zatuchni scoring system is

47
Q

The possible points for parity in the zatuchni scoring system are

A

Primigravida = 0
Multigravida = 1

48
Q

The points assigned to gestational age in the zatuchni scoring system are

A

> /=39 weeks — 0
38 weeks — 1
</=37 weeks — 2

49
Q

38 weeks GA has a score of — in the Zatuchni scoring system

50
Q

A score of 1 for GA in the ZAS is for

51
Q

A score of 2 for GA is assigned for — in ZAS

A

</=37 weeks

52
Q

When is a score of 0 assigned for GA in ZAS

A

> /= 39 weeks

53
Q

All indices in ZAS can have points 0, 1 or 2 except for which index

A

Parity which has either point 0 for primigravidity or 1 for multigravida

54
Q

A point of 2 for EFW in ZAS is for

55
Q

A point of 1 for EFW in ZAS is for

A

3.1 to 3.6kg

56
Q

A point of 0 for EFW in ZAS is for

57
Q

For previous vaginal breech delivery in ZAS, point 0 is for

58
Q

For previous vaginal breech delivery in ZAS, point 1 is for

A

one previous breech delivery

59
Q

For previous vaginal breech delivery in ZAS, point 2 is for

A

2 or more previous breech deliveries

60
Q

A score of 2 for cervical dilation in ZAS is for

A

4cm or more

61
Q

A score of 0 for cervical dilation in ZAS is for

A

2cm dilation

62
Q

A score of 1 for cervical dilation in ZAS is for

A

3cm dilation

63
Q

For station in ZAS 0 point is for

A

-3 station

64
Q

For station in ZAS 1 point is for

A

station -2

65
Q

For station in ZAS 2 points is for

A

station -1 or lower

66
Q

A total score of 6 and above in ZAS indicates

A

a reasonable chance for a successful vaginal delivery.

67
Q

— total score in ZAS indicates a need for CS

68
Q

A total score of 4 or 5 in ZAS indicates

A

a need for careful review of the mode of delivery. Explain the risk of proceeding with vaginal delivery to the parturient and consent. Otherwise, plan for caesarean delivery.

69
Q

The easiest maternal position for intrapartum management of vaginal breech delivery is

A

propped -up dorsal position

70
Q

When should the mother assume lithotomy position in vaginal breech delivery

A

after delivery of the baby’s body

71
Q

The manoeuvre for delivering extended legs in assisted vaginal breech delivery

A

Pinnard’s manoeuvre

72
Q

The manoeuvre for delivering nuchal arms in assisted vaginal breech

A

Lovset manoeuvre

73
Q

3 indications for breech extraction

A

Delivery of the second twin in twin gestation.

Delay in the second stage of labour with fetal compromise, or

A dead fetus

74
Q

T/F: Do not augment a patient with dysfunctional labour during breech delivery

A

T
as this might be a pointer to underlying complications with subsequent poor outcome.

WACS (19 decks)

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