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Vaginal Breech
Delivery
Vaginal Breech
Delivery
International
Vaginal Breech
Delivery
Objectives
Incidence and Significance
Selection
Management
Intrapartum
Delivery
International
Vaginal Breech
Delivery
Definition
longitudinal lie
breech or lower extremity presenting
cephalic pole in the uterine fundus
Types
frank
complete
footling
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Vaginal Breech
Delivery
Types of Breech
Complete
Footling
Frank
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Vaginal Breech
Delivery
Incidence
3 to 4% of all pregnancies
increases with decreasing gestational age
7 to 10% at 32 weeks
25 to 35% at < 28 weeks
Vaginal Breech
Delivery
International
idiopathic
prematurity (head to trunk size)
uterine or pelvic structural abnormality
uterine fibroid
fetal anomaly or abnormality
polyhydramnios
multiple gestation
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Vaginal Breech
Delivery
Diagnosis
maternal perception of movement
Leopolds maneuvers
FH auscultated above umbilicus
vaginal exam
ultrasound
X-ray
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Vaginal Breech
Delivery
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Vaginal Breech
Delivery
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Vaginal Breech
Delivery
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
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Vaginal Breech
Delivery
Vaginal Breech
Delivery
International
Management in Labour
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Vaginal Breech
Delivery
Management at Delivery
experienced newborn resuscitator present
empty maternal bladder
maternity attendant with experience in breech
delivery
forceps if available, may be helpful
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Vaginal Breech
Delivery
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Vaginal Breech
Delivery
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Vaginal Breech
Delivery
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)
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Vaginal Breech
Delivery
International
Vaginal Breech
Delivery
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Vaginal Breech
Delivery
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)
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Vaginal Breech
Delivery
Avoid Over-extension
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Vaginal Breech
Delivery
International
Vaginal Breech
Delivery
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Vaginal Breech
Delivery
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Vaginal Breech
Delivery
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
Vaginal Breech
Delivery
International
Conclusions