Y2 Breech Flashcards
Which are the three types of breech presentation?
Complete breech 30% (lotus position, bum first)
Incomplete breech (footling)
Frank breech 65-70% (legs up, preferred)
What risk factors could cause baby to be breech?
Previous breech Prematurity High parity Oligo/polyhydramnios Multiple pregnancy Uterine anatomy abnormality Fetal abnormalities Placentation (previa, cornual)
How many percentage of births are breech presentations?
3-4 %
Which are success factors for a breech vaginal birth?
Skilled practitioners, a committed mother, a healthy fully grown fetus in frank position.
Should a mother with an incomplete breech (footling) baby be offered to give birth vaginally?
?NO
What risk factors should be considered before attempting a vaginal breech birth?
2000> fetal weight <3800 Placental insuficiency Incomplete breech Hyperextended head Previous CS Presence of skilled practitioners Access to theatre
When you discover an undiagnosed breech presentation in labour, make sure to… ?
Get the per son with the most experience in the room asap.
How common are cord prolapse in vaginal breech birth?
1%
What differentiates care on 1st stage of labour?
Nothing
Why is meconium not as bad a sign when baby is breech?
As the cause of the meconium is mechanical compression of the babys abdomen rather than a sign of hypoxia.
Why is it less favourable to give birth with epidural or in the pool when breech?
As gravity is central to progression.
Why should pushing be discouraged before VE has confirmed full dilation?
Risk of head getting stuck, especially when baby is preterm.
Why is the 2nd stage more stressful to baby when breech?
Due to cord compression
If presenting part is not visible after 1h (prim)/30 mins (parus) of puching, this could indicate?
Fetopelvic disproportion
Why would continuous monitoring be advised?
Due to the increased risk of cord compression/prolaps
Why should a person skilled in resuscitation be present at birth?
As baby is more likely to be hypoxic and in need of rescus
To minimise risks, the threshold for section is ?
LOW
When the breech baby is descending down the birth canal it is important to?
Be hands off
Why should you let legs birth without aid?
To allow the perineum to distend.
How long should it approximately take from the birth of the bottom until the shoulders are out?
2 mins
Should you routinely aid the birth of the arms?
NO, they are usually born spontaneously.
Is it dangerous for the baby to hang from the vagina when the body is born but not the head? How long could this be allowed to happen?
No, the pull from gravity will encourage the birth of the head, hands off. This is ok for tops 30 seconds.
Why is it important to not pull on the baby when the body is birthed but not the head?
To avoid head extension
If the buttock is birthed but it not the legs and feet, the practitioner can?
apply pressure on the backside of babys knees to aid them coming out, popliteal pressure.
If baby does not rotate, the practitioner can?
Make sure the babys back is toward maternal tummy, rotation from babys hips without touching the umbilical cord as this could cause it to go into spasm
After 30 sec of maternal effort without elbows coming out, the pracitioner can?
examine to see the postition of the shoulders and arms, and sweep them out in front of the baby. Baby might have to be rotated by the hips for the arms to be reached, Lovsetts manoeuvre. IF THER IS ANY RESTISTANCE< DO NOT PROCEED.
If the head is not birthed, the practitioner can?
use the Mericeau-Smellie-Veit manoeuvre (MSV).
This involves suprapubic pressure and index+ring finger of the other hand on babys cheekbones to encourage flexion of the head, anterior hand moves to push back of babys head to further aid flexion. Birth slowly. The babys body should simultaneously be supported and at birth, lifted onto mothers chest.
Forceps or Burn-Marshall method can also be used with extreme causion.
What should always be done after a breech vaginal delivery?
Cord gases
Hip scan referral
