Breech presentation1
Download as PPTX, PDF2 likes247 views
This document discusses breech presentation in pregnancy. It defines breech presentation and notes that the incidence is around 3-4% at term, though higher for preterm births. Risk factors for breech presentation include primigravidity, uterine anomalies, fetal anomalies, preterm labor, and multiple pregnancy. Diagnosis methods include clinical examination, ultrasound, CT/MRI, and X-ray. The document outlines methods of breech delivery including spontaneous vaginal delivery, assisted breech delivery, and breech extraction. It describes maneuvers like Lovset's maneuver and notes complications for both the mother and fetus from breech delivery. External cephalic version is discussed as an option to attempt turning the breech baby, along
Breech presentation1
- 2. • Definition • Lie • Presentation • Incidence 20%. -28 week 5% -34 week 3-4% by term
- 3. Broad head accommodate roomy fundus
- 4. Etiology of breech presentation • Preterm • Preventing spontaneous version – Frank breech,twins,oligohydramnion,uterine malformation,short cord • Favouring breech– Hydrocephalus,placenta previa,contracted pelvis,cornufundal attachemet of placeta
- 5. 3-4% of fetus present by breech at term 7% at 32 weeks 25% at 28 weeks 20% diagnosed initially in labour Incidence
- 6. Causes / Risk Factors Primigravida Uterine anomalies Uterine fibroids Pelvic anatomy Fetal anomalies Multiple pregnancy Preterm labour Oligohydraminos / polyhydramnios Grand multiparity Fetal death
- 10. • Uncomplicated breech • Complicated breech • Complication of breech delivery
- 12. Diagnosis • Clinical examination • Ultrasonogram • CT/MRI • X-ray
- 14. Methods of breech delivery Spontaneous Assisted breech delivery Breech extraction
- 15. Breech Delivery The cervix should be fully dilated and the fetal anus visible on the perineum for active second stage.
- 16. Breech Delivery The woman should be in lithotomy position.
- 17. Breech Delivery Delivery of the breech should be ‘hands off’ Legs and abdomen are born spontaneously.
- 18. Breech Delivery Ensure that the fetal back rotates uppermost by carefully grasping the fetal pelvis with fingers & thumbs
- 19. Breech Delivery The fetus should be allowed to hang once the legs and abdomen have emerged until the wings of the scapula are seen.
- 20. Lovset’s Manoeuvre Grasp the fetus around the bony pelvis with the thumbs across the sacrum. The fetal back should then be turned through 180 degrees until the posterior arm comes to lie anteriorly…….
- 21. Lovset’s Manoeuvre The elbow will appear below the symphysis pubis and the arm is delivered by sweeping it across the fetal body. The manoeuvre is repeated in reverse to deliver the other arm.
- 22. Lovset maneuver
- 23. Breech Delivery Allow the fetus to hang from the vulva until the nape of the neck is visible. Then carry out Mauriceau-Smellie- Veit manoeuvre
- 24. Delivery of after coming head
- 25. Complications of breech delivery Maternal Operative delivery Birth Injury
- 26. Fetal complications Perinatal mortality Intracranial haemorrhage Vault fracture Birth asphyxia Birth injuries • Sternomastoid hematoma • Fracture of femur,humourus,clavicle. • Visceral injuries • Nerve injuries
- 27. External cephalic version • 37 week • Benefits of ECV • Dangers of version • Anti - D
- 28. External Cephalic Version Best evidence states that E C V should be offered late in pregnancy Success rate increased with: multiparity adequate liquor station of breech above the pelvic brim
- 29. Technique NST TOCOLYTICS LEFT LATERAL POSITION TRENDLENBURGE POSITION FORWARD FLIP BACKWARD FLIP INTERMITENT ASCULATATION
- 31. Contraindications of ECV Any contraindications of vaginal delivery Scared uterus In labour Rh -ve Oligohydramnion
- 32. Complications of ECV Preterm labour PROM Abruption Entanglement of cord Fetomaternal bleed Amniotic fluid embolism
- 33. Thank you