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    Breech Presentation and Its Management2

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    maezu
    This document discusses breech presentation and its management. It defines breech presentation as when the cephalic pole is in the uterine fundus and the caudal pole is at the pelvic brim. It describes the three types of breech presentation and discusses techniques to diagnose and manage breech presentation, including external cephalic version and the options for delivery. External cephalic version aims to achieve a vertex presentation and decrease C-section rates. Vaginal breech delivery can be attempted if certain criteria are met, otherwise C-section is recommended due to safety concerns.

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    Breech Presentation and Its Management2

    Uploaded by

    maezu
    2K views17 pages
    This document discusses breech presentation and its management. It defines breech presentation as when the cephalic pole is in the uterine fundus and the caudal pole is at the pelvic brim. It describes the three types of breech presentation and discusses techniques to diagnose and manage breech presentation, including external cephalic version and the options for delivery. External cephalic version aims to achieve a vertex presentation and decrease C-section rates. Vaginal breech delivery can be attempted if certain criteria are met, otherwise C-section is recommended due to safety concerns.

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    This document discusses breech presentation and its management. It defines breech presentation as when the cephalic pole is in the uterine fundus and the caudal pole is at the pelvic brim. It describes the three types of breech presentation and discusses techniques to diagnose and manage breech presentation, including external cephalic version and the options for delivery. External cephalic version aims to achieve a vertex presentation and decrease C-section rates. Vaginal breech delivery can be attempted if certain criteria are met, otherwise C-section is recommended due to safety concerns.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as ppt, pdf, or txt
    2K views17 pages

    Breech Presentation and Its Management2

    Uploaded by

    maezu
    This document discusses breech presentation and its management. It defines breech presentation as when the cephalic pole is in the uterine fundus and the caudal pole is at the pelvic brim. It describes the three types of breech presentation and discusses techniques to diagnose and manage breech presentation, including external cephalic version and the options for delivery. External cephalic version aims to achieve a vertex presentation and decrease C-section rates. Vaginal breech delivery can be attempted if certain criteria are met, otherwise C-section is recommended due to safety concerns.

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    of 17

    .

    BREECH PRESENTATION
    AND ITS MANAGEMENT.

    BREECH PRESENTATION AND


    ITS MANAGEMENT.
    Diagnosed when cephalic pole in the uterine
    fundus and caudal pole at the pelvic brim.
    Commonest mal-presentation.
    Incidence 25% at 28 weeks of gestation
    7% at 32weeks
    5% at 34 weeks and
    3-4% at term
    3 out of 4 spontaneous correction in to
    vertex presentation by 34 weeks.

    12/02/16

    THREE TYPES OF BREECH


    PRESENTATION
    1. Frank breech-hips are flexed with
    extended knees
    bilaterally.
    2.complete breech-both hips and
    knees are
    flexed.
    3.footling breech-legs are extended
    below
    the level of the
    buttocks.
    12/02/16

    AETIOLOGY OF BREECH
    PRESENTATION.
    Remains obscure in significant number of
    cases.
    Prematurity
    Factors preventing spontaneous versionabnormal placentation.
    Undue mobility of the fetuspolyhydramnios.
    Fetal abnormality.
    Recurrent/habitual breech.
    12/02/16

    Diagnosis of breech
    presentation.
    History-fetal kick low in the
    abdomen.
    Physical examination-abdominal
    palpation,FHB auscultation,pelvic
    examination.
    Ultra sound examination.

    12/02/16

    MANAGEMENT OF BREECH
    PRESENTATION.
    1-Antenatal management Identification of complicating factors
    like congenital malformations of the
    uterus and the fetus,placental
    location,amniotic fluid volume External cephalic version.

    12/02/16

    EXTERNAL CEPHALIC
    VERSION.
    Objective:
    To have vertex presentation in labour that is associated
    with minimal risk to the mother and fetus

    Indication:
    Non cephalic presentation at or after 36 weeks of
    gestation

    Benefits:
    Decrease incidence of breech presentation at
    term,
    Decrease the incidence of breech delivery and
    associated complications,
    Decrease the incidence of C/S delivery by about
    5%.

    12/02/16

    TECHNIQUES AND STEPS


    IN EXTERNAL CEPHALIC
    VERTION.
    Ultra sound examination
    Should be done in labour and
    delivery unit
    BPP done to assess fetal well being
    Tocolytic drugs to relax the uterus-terbutalin 250mg sc 20 minutes
    prior.
    12/02/16

    ACTUAL STEPS IN ECV.

    STEP 1
    Mobilize the breech to one illiac fossa.
    Podalic pole by the right hand and head by
    the left hand.
    STEP 2
    Pressure exerted to opposite directions to
    keep the trunk well flexed.
    STEP 3
    The hand changed one after the other to hold
    the fetal poles to prevent crossing of the hand
    Check FHR after each attempt
    Anti-D immunoglobulin to Rh negative non12/02/16
    9
    sensitized mother.

    ACTUAL STEPS IN EXTERNAL


    CEPHALIC VERSION
    The mother to be observed for about 30
    minutes.
    Instructions given to the mother and follow up.
    Some causes of failure in ECV
    -Breech with extended legs
    -Scanty liquor or big baby.
    -Short cord.
    -Mechanical obesity,increased tone of
    abdominal muscles.
    -Uterine malformations.
    12/02/16

    10

    COMPLICATIONS
    Placental abruption.
    Cord entanglement and sudden fetal
    death.
    PROM.
    Pre-term labour.
    Increased feto-maternal bleeding.
    Amniotic fluid embolism.
    Uterine scar dehiscence.
    12/02/16

    11

    CONTRA INDICATIONS FOR


    ECV.

    Multiple pregnancy.
    Evidence of utero-placental insufficiency.
    APH
    Suspected IUGR,IUFD.
    Amniotic fluid abnormalities.
    Uterine malformations.
    Maternal cardiac disease,hypertension.
    Scared uterus,major fetal
    anomalies,ruptured membrane,bad
    obstetric history,contracted pelvis.
    None- reasuring fetal heart rate pattern.
    12/02/16

    12

    Mode of delivery in breech


    1. C/S
    2. Vaginal

    12/02/16

    13

    VAGINAL BREECH DELIVERY.


    Cases with no absolute maternal or
    fetal indications for direct C/S.
    EFW<3500 grms.
    Frank or complete breech.
    Flexed head and adequate pelvis.
    Gross fetal malformations judged to
    be incompatible with extra uterine
    life.
    12/02/16

    14

    VBD

    1-spontaneous vaginal breech delivery.


    2-breech extraction.
    alternative to emergency C/S in
    desperate conditions.
    some of the indications are:
    fetal distress in second stage,
    delivery of the second twin after
    internal podalic version
    cord prolapse or entanglement around
    the leg
    extended legs arrested at the cavity
    or at the outlet.

    12/02/16

    15

    The preconditions are


    fully dilated cervix
    no mechanical obstruction,
    no uterine scare,
    mother should not be grand multiparous
    3. Assisted Breech Delivery

    12/02/16

    16

    Assisted breech delivery.


    Should be employed in all cases.
    Patient kept in lithotomy position and
    bladder emptied.
    Vaginal examination to ascertain full
    cervical dilatation,presence of cord
    prolapse.
    Do episiotomy when the fetal anus is
    visible and perineum distended.
    Wait with out intervention till body is born
    to the level of the umbilicus.
    12/02/16

    17

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