1 / 25

Vaginal Breech Delivery

Vaginal Breech Delivery. Objectives Incidence and Significance Selection Management Intrapartum Delivery. Definition longitudinal lie breech or lower extremity presenting cephalic pole in the uterine fundus Types frank - flexed hips, extended knees

cheriel
Download Presentation

Vaginal Breech Delivery

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Vaginal Breech Delivery

  2. Objectives • Incidence and Significance • Selection • Management • Intrapartum • Delivery

  3. Definition • longitudinal lie • breech or lower extremity presenting • cephalic pole in the uterine fundus • Types • frank - flexed hips, extended knees • complete - flexed hips, flexed knees • footling - extended hip(s)

  4. Types of Breech • Frank • Footling • Complete

  5. Incidence • 3 to 4% of all pregnancies • increases with decreasing gestational age • 7 to 10% at 32 weeks • 25 to 35% at < 28 weeks

  6. Etiology of Breech Presentation • idiopathic • prematurity (head to trunk size) • uterine or pelvic structural abnormality • uterine fibroid • fetal anomaly or abnormality • polyhydramnios • multiple gestation

  7. Diagnosis • maternal perception of movement • Leopold’s maneuvers • FH auscultated above umbilicus • vaginal exam • ultrasound • X-ray

  8. Recommendations for Breech Delivery • recommend trial of labour at  36 weeks or when estimated weight is 2500 to 4000 grams • offer trial of labour at 31 to 35 weeks gestation or when estimated weight is 1500 to 2500 grams • offer caesasean section at  30 weeks gestation or when estimated weight is < 1500 grams* • no recommendation for when estimated weight is > 4000 grams* • * acknowledged lack of evidence for recommendation

  9. Selection Criteria for Trial of Labour • frank or complete breech • fetal head not hyperextended • estimated fetal weight 2500 to 4000g

  10. Ultrasound Assessment • confirm lie and type of breech • assess head position • obtain estimate of fetal weight • assess for IUGR and congenital anomalies • assess amniotic fluid volume • confirm placental localization

  11. Contraindications to Trial of Labour • fetal or maternal contraindication to labour • footling breech • hyperextension of the fetal head • absence of informed consent • absence of experienced maternity health care giver

  12. Management in Labour • planned delivery in hospital • admission in early labour or with ROM • appropriate fetal surveillance • epidural and ARM for usual indications • immediate vaginal exam at ROM to rule out cord prolapse • good progress in labour ( 0.5 cm/h after 3 cm) • induction and augmentation permissible

  13. Management at Delivery • experienced newborn resuscitator present • empty maternal bladder • maternity attendant with experience in breech delivery • forceps if available, may be helpful

  14. Entering the Pelvis • Obstetrics - Normal and Problem Pregnancies, 2nd Edition • Edited by SG Gabbe, JR Niebyl, JL Simpson. (1991)

  15. Descent of the Breech • Obstetrics - Normal and Problem Pregnancies, 2nd Edition • Edited by SG Gabbe, JR Niebyl, JL Simpson. (1991)

  16. Spontaneous Expulsion • spontaneous expulsion to the umbilicus • the sacrum should be gently guided anteriorly • singleton breech extraction is contraindicated • C/S is indicated for failure of descent or expulsion • Obstetrics - Normal and Problem Pregnancies, 2nd Edition • Edited by SG Gabbe, JR Niebyl, JL Simpson. (1991)

  17. Hurry up & Wait! • DON’T PULL! • traction deflexes the fetal head • may cause nuchal arm • Obstetrics - Normal and Problem Pregnancies, 2nd Edition • Edited by SG Gabbe, JR Niebyl, JL Simpson. (1991)

  18. Deliver Legs by lateral rotation of thighs and flexion of knees - keep sacrum anterior • Obstetrics - Normal and Problem Pregnancies, 2nd Edition • Edited by SG Gabbe, JR Niebyl, JL Simpson. (1991)

  19. Delivery of Arms • good maternal pushing • deliver when winging of scapulae seen • rotate arm to anterior • sweep humerus across the chest and deliver • rotate other arm anterior and repeat to deliver • Obstetrics - Normal and Problem Pregnancies, 2nd Edition • Edited by SG Gabbe, JR Niebyl, JL Simpson. (1991)

  20. Avoid Over-extension • Obstetrics - Normal and Problem Pregnancies,2nd Edition • Edited by SG Gabbe, JR Niebyl, JL Simpson. (1991)

  21. Delivery of the head • Mauriceau - Smellie - Veit manoeuvre to deliver the head in flexion • The body should be supported in a horizontal position

  22. Delivery of the head • Obstetrics - Normal and Problem Pregnancies, 2nd Edition • Edited by SG Gabbe, JR Niebyl, JL Simpson. (1991)

  23. Delivery of the head • Forceps • assistant elevating babe • direct application • Obstetrics - Normal and Problem Pregnancies, 2nd Edition • Edited by SG Gabbe, JR Niebyl, JL Simpson. (1991)

  24. Prevention of Breech • consider external cephalic version at  36 weeks gestation for eligible candidates • success rate 30 - 70% depending on experience • results in lower cesarean section rate

  25. Conclusions • proper selection of patients • thorough explanation and informed consent • good progress in labour (  0.5 cm/h after 3 cm) • induction and augmentation permissible • experienced attendants • standard fetal monitoring • assisted delivery - DON’T PULL - stay cool!

More Related