Mechanism Of Labor In Breech Presentation 2bas
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MECHANISM OF LABOR IN BREECH PRESENTATION
dr. Udin Sabarudin Department of Obstetrics & Gynecology Medicine School of Padjadjaran University Bandung
THE 3 TYPES OF BREECH PRESENTATION • Frank (65%)
: Hips are flexed, knees are extended. • Complete (10%) : The hips and knees are flexed • Incomplete (25%) : The feet or knees are the lowermost presenting part. o Single footling : one of the lower extremities is lowermost. o Double footling : Both of the lower extremities are lowermost
Figure 21-2. Breech presentations. A: Right sacrum posterior (RSP) position. B: Left sacrum anterior (LSA) position. (Redrawn and reproduced, with permission, from Bumm E: Grundiss zum Studium der Geburtshilfe. Bergmann, 1922)
PREDISPOSING FACTORS :
Prematurity
Uterine abnormalities : -Malformation; -Fibroids
Fetal abnormalities
Multiple gestations
Previous breech delivery
: -CNS Malformations; -Neck Masses
Gestational age and frequency of breech birth Gestational age in weeks
% Breech
21-24
33
25-28
28
29-32
14
33-36
9
37-40
7
DIAGNOSIS :
Palpation and ballottement
Ultrasound
Pelvic examination
X-Ray studies
Leopold Maneuver
External Cephalic Version
T
MANAGEMENT DURING LABOR Type of Delivery
Vaginal delivery: Spontaneous
Partial
breech extraction Total breech extraction
Cesarean of delivery
Management
Three types of vaginal breech delivery exist
Spontaneous breech (rare) : No manipulation of the infant is necessary, other than ing the infant.
Partial breech extraction : Fetus descend spontaneously to where umbilicus is at the vaginal introitus; then, the fetus is extracted completely.
Total breech extraction : The entire body is extracted. This is indicated only if there is evidence of fetal distress unresponsive to routine maneuvers and a cesarean delivery is not possible.
Conditions are unfavorable for breech delivery Fetus weight more than 3500 g
Unfavorable pelvis – Breech delivery
does not allow sufficient time for molding of the fetal head; thus, a platypelloid or android pelvis decreases ability fetal head to navigate maternal pelvis
Hyperextension of the head – increases risk of
cervical spine injury
Footlings- incidence of umbilical cord prolapse
increases with coiling of the umbilical cord around the legs of the fetus
MORTALITY/MORBIDITY Increased birth trauma: As duration of
umbilical cord compression increases → deliver the infant more rapidly → increasing birth trauma Decreased birth weight may result from preterm delivery/growth restriction Incidence of prolapsed umbilical cord depends on type of breech presentation : Footling 17%, Complete 5%, Frank 0,5%
Mechanism of Labor in Breech Delivery
Assisted Delivery of Frank Breech
Assisted Delivery of Frank Breech
Assisted Delivery of Frank Breech
Assisted Delivery of Frank Breech
Assisted Delivery of Frank Breech
Assisted Delivery of Frank Breech
Assisted Delivery of Frank Breech
Mechanism of Labor in Breech Delivery
Figure 21-5. Maneuver for delivery of the head. The fingers of the left hand are inserted into the infant’s mouth of over mandible; the right hand exerts pressure on the head from above. (Modified and reproduced, with permission, from Benson RC:Handbook of Obstetrics & Gynecology, 8th ed. Lange, 1983)
Mauriceau Maneuver
Delivery of the Aftercoming Head
Piper forceps
Modified prague maneuver
Mechanism of Labor in Breech Delivery
Figure 21-12. Application of Piper forceps, employing towel sling . The forceps are introduced from below, left blade first. Aiming directly and intended positions on sides of the head. (Reproduced, with permission, from Benson RC:Handbook of Obstetrics & Gynecology, 8th ed. Lange, 1983)
Forceps to Aftercoming Head
Modified Prague Maneuver
Complete or Incomplete Breech Extraction
Complete or Incomplete Breech Extraction
Complete or Incomplete Breech Extraction
Complete or Incomplete Breech Extraction
Breech Extraction
C-Section Indication
A large fetus ( > 3.500 gr )
A Hyperextended fetus
Uterine dysfunction
Footling presentation
Any degree of contraction or unfavorable shape restriction
Previous perinatal death or children suffering from birth trauma
COMPLICATIONS 1. Perinatal morbidity and mortality from difficult delivery
2. Low birthweight from preterm delivery, growth restriction, or both 3. Prolapsed cord 4. Placenta previa 5. Fetal, neonatal, and infant anomalies
6. Uterine anomalies and tumors 7. Multiple fetuses 8. Operative intervention, especially cesarean delivery
dr. Udin Sabarudin Department of Obstetrics & Gynecology Medicine School of Padjadjaran University Bandung
THE 3 TYPES OF BREECH PRESENTATION • Frank (65%)
: Hips are flexed, knees are extended. • Complete (10%) : The hips and knees are flexed • Incomplete (25%) : The feet or knees are the lowermost presenting part. o Single footling : one of the lower extremities is lowermost. o Double footling : Both of the lower extremities are lowermost
Figure 21-2. Breech presentations. A: Right sacrum posterior (RSP) position. B: Left sacrum anterior (LSA) position. (Redrawn and reproduced, with permission, from Bumm E: Grundiss zum Studium der Geburtshilfe. Bergmann, 1922)
PREDISPOSING FACTORS :
Prematurity
Uterine abnormalities : -Malformation; -Fibroids
Fetal abnormalities
Multiple gestations
Previous breech delivery
: -CNS Malformations; -Neck Masses
Gestational age and frequency of breech birth Gestational age in weeks
% Breech
21-24
33
25-28
28
29-32
14
33-36
9
37-40
7
DIAGNOSIS :
Palpation and ballottement
Ultrasound
Pelvic examination
X-Ray studies
Leopold Maneuver
External Cephalic Version
T
MANAGEMENT DURING LABOR Type of Delivery
Vaginal delivery: Spontaneous
Partial
breech extraction Total breech extraction
Cesarean of delivery
Management
Three types of vaginal breech delivery exist
Spontaneous breech (rare) : No manipulation of the infant is necessary, other than ing the infant.
Partial breech extraction : Fetus descend spontaneously to where umbilicus is at the vaginal introitus; then, the fetus is extracted completely.
Total breech extraction : The entire body is extracted. This is indicated only if there is evidence of fetal distress unresponsive to routine maneuvers and a cesarean delivery is not possible.
Conditions are unfavorable for breech delivery Fetus weight more than 3500 g
Unfavorable pelvis – Breech delivery
does not allow sufficient time for molding of the fetal head; thus, a platypelloid or android pelvis decreases ability fetal head to navigate maternal pelvis
Hyperextension of the head – increases risk of
cervical spine injury
Footlings- incidence of umbilical cord prolapse
increases with coiling of the umbilical cord around the legs of the fetus
MORTALITY/MORBIDITY Increased birth trauma: As duration of
umbilical cord compression increases → deliver the infant more rapidly → increasing birth trauma Decreased birth weight may result from preterm delivery/growth restriction Incidence of prolapsed umbilical cord depends on type of breech presentation : Footling 17%, Complete 5%, Frank 0,5%
Mechanism of Labor in Breech Delivery
Assisted Delivery of Frank Breech
Assisted Delivery of Frank Breech
Assisted Delivery of Frank Breech
Assisted Delivery of Frank Breech
Assisted Delivery of Frank Breech
Assisted Delivery of Frank Breech
Assisted Delivery of Frank Breech
Mechanism of Labor in Breech Delivery
Figure 21-5. Maneuver for delivery of the head. The fingers of the left hand are inserted into the infant’s mouth of over mandible; the right hand exerts pressure on the head from above. (Modified and reproduced, with permission, from Benson RC:Handbook of Obstetrics & Gynecology, 8th ed. Lange, 1983)
Mauriceau Maneuver
Delivery of the Aftercoming Head
Piper forceps
Modified prague maneuver
Mechanism of Labor in Breech Delivery
Figure 21-12. Application of Piper forceps, employing towel sling . The forceps are introduced from below, left blade first. Aiming directly and intended positions on sides of the head. (Reproduced, with permission, from Benson RC:Handbook of Obstetrics & Gynecology, 8th ed. Lange, 1983)
Forceps to Aftercoming Head
Modified Prague Maneuver
Complete or Incomplete Breech Extraction
Complete or Incomplete Breech Extraction
Complete or Incomplete Breech Extraction
Complete or Incomplete Breech Extraction
Breech Extraction
C-Section Indication
A large fetus ( > 3.500 gr )
A Hyperextended fetus
Uterine dysfunction
Footling presentation
Any degree of contraction or unfavorable shape restriction
Previous perinatal death or children suffering from birth trauma
COMPLICATIONS 1. Perinatal morbidity and mortality from difficult delivery
2. Low birthweight from preterm delivery, growth restriction, or both 3. Prolapsed cord 4. Placenta previa 5. Fetal, neonatal, and infant anomalies
6. Uterine anomalies and tumors 7. Multiple fetuses 8. Operative intervention, especially cesarean delivery
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