Breech Presentation 5n51p

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DEFINITION ! | ! ! | ! ! ! |

TYPES OF BREECH PRESENTATIONS ! | !

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AETIOLOGY ! MATERNAL ! ! !

MULTIPARITY CONTRACTED PELVIS MALFORMATIONS OF UTERUS PELVIC TUMOURS PREVIOUS BREECH

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! PLACENTAL ! ! ! !

PLACENTA PREVIA CORNUO FUNDAL PLACENTA HYDRAMNIOS OLIGOHYDROMNIOS

! FETAL ! ! ! ! ! !

PREMATURITY CONGENITAL FETAL MALFORMATIONS HABITUAL OR RECURRENT BREECHCONGENITAL MALFORMATIONS OF THE UTERUS REPEATED CORNU FUNDAL ATTACHMENT OF PLACENTA

! ! ! ! ! !

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DIFFERENT POSITIONS OF BREECH

DIAGNOSIS OF BREECH ! | ! | 1 |

! Ô Ô ! !

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! During Labor ! '#,,(!(&'!&!*+%-(&2" (',(')"3-#)('#/ 4#5('#!(&'%-#/"6 ! *7&'8/#',5#%9"& 7%$*'#5/8("$*(#/ !27%&"(!("#',#'#/&%( ($#%('#"!%#()*!/(' ! * !#% /!7"(,!*72!!&$9"('$&5+/! 7%$* ! %"*5$&'(255#87 &2',&'!*4#5('(') (')%" ! #/)'(!#/(#5#87 /!

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D !!#" ! "$'!#',')#)5'! ! #,'!%"!*+/-("('!* &++&"(!&7/(=2,(#5!% ! /4(&' ! '!%'#/%&!#!(&' ! *&$$(+2!$&5"2',%!* +27($"85+*8"(" ! |(%!*& !**#,78 /4(&' ! *'#+& !*'$9+(-&!" 2',%!*"85+*8"("+27("#', !*$*('35&2!*3'&"3 &%*#,3 7%)5#3#',&$$(+2!#%7&%' 785&-5'!& /4(&'

! Depends on age and parity and past obstetric performance. ! Weight and maturity. ! Type of breech. ! Pelvic configuration. ! Uterine dysfunction. ! Other complications. ! Skill of obstetrician

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% & & "

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% & & " ! Methods !

1-forward roll

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2-backward flip

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Method ʹ Place ʹin a unit where facilities for LSCS Position-supine with relaxed abdomen. Patient ʹwith empty bladder. Obstetrician should stand on right side of the patient with hands on fundus and lower pole. ! Movements ʹdisplace breech out of pelvis, push the head towards pelvis.

'( ! ! ! ! ! !

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ECV Algorithm ?

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Add 0 Points

Add 1 Point

Add 2 Points

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EFW (lb)



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Previous breech

0

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Dilatation

2

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Station

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-2

Parity Gestational age (wk)

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& ! IN 1ST STAGE! cord prolapse ! fetal distress ! In 2nd stage ʹ ! non progress of labor ! fetal distress

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! 1.spontaneous ! 2.assisted breech delivery ! J.breech extraction

Complicated breech ! ! ! ! ! ! !

PROM Cord prolapse Uterine inertia Impacted breech Impacted shoulder ʹextended arms nuchal arms After coming head-

! !! ! ! ! ! ! ! !

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3a age e t f arrest at tt cks i ar s a e ver ! I tr ce e ha i t the ter s. ! Reach the p pliteal f ssa al g the thigh. ! N w press re is applie al g ackwar a twar irecti which ca ses flexi f the k ee a f t falls w . ! B th feet ca e r ght w i this way.

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Arrest at the neck ! Occasionally the cervix clamps down around the baby͛s neck after the trunk and shoulders have born.

! In this case incisions at 2͛0 and 10 ͚o clock positions on the cervix with the scissors. (/

3 ! One of the measures should be under taken. 1. Mauriceau smellie veit maneuver 2. Pipers forceps for the after coming head J. Modified prague maneuver

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Application of pipers forceps ! Assistant lifts the baby͛s body up. ! Introducing the right hand between head and left posterior wall of vagina ,left blade is inserted into a mento occipital position. ! Like wise the left blade is introduced. ! The forceps are locked and traction is applied.

3 (( ! used when fetal back is posterior.

! With one hand operator catches the shoulders of the baby and with other hand lifts the baby up.

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Failure of descent of the breech ! In spite of good uterine contractions if there is no proper descent disproportion should be suspected. ! In this case ! cesarean section should be performed. ! Decomposition can be done.(Decomposition is reducing the bulk of the breech.) ! In case of frank breech Pinard͛s maneuver should be carried out.

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Breech extraction ! 55,(#!-#)('#/4!%#$!(&'& !*7#78 ;*'"()'"& !#/,("!%"",5#',,/(-%8 ;(!*&2!,/#8 ! %%=2("(!" ! ,=2#!+/-(" ! %-(452"!7 2//8,(/#!, ! |/#,,%#',%$!25"*&2/,75+!8 ! 4+%!#',,+#'"!*"(#

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