Abnormal lie Flashcards
How to confirm presentation
Ultrasound
Risks of malpresentation
Perinatal morbidity and mortality
Cord prolapse
Emergency C section
Options for intervention
Wait to see if fetus turns spontaneously
External cephalic version from 36 weeks
Elective C section
Risks of external cephalic version
Failure
Discomfort
Risk of fetus turning back
Fetal distress requiring immediate delivery
When is an elective C section done
39 weeks
Management in breech presentation
Consultant antenatal appointment Admission to hospital No induction ECV 37-38 weeks If failed ECV offer C section
When should patient be admitted
37 weeks
What is unstable lie
Lie keeps changing after 37 weeks
In breech presentation, when should C section be advised
Large baby Footling breech High maternal BMI Para 1 Placenta praevia or low fibroid Failed ECV
Describe ECV
NBM for 6 hours US to check position of fetus, possible reasons for position/lie e.g uterine septum, liquor volume and placenta praevia CTG before Smooth muscle relaxant injection Attempt to correct position of fetus CTG after US to confirm success
Contraindications for ECV
Before 36 weeks gestation
Fetal distress
BMI >40
If NVD unlikely e.g placenta praevia, previous C/S
Physical barrier e.g uterine abnormality (septum, bicornuate, fibroid) or ovarian cyst
Oligohydramnios
Multiple pregnancy
Established labour (ruptured membranes and contractions)
Recent PV bleeding
Risk factors for breech
Multiple pregnancy Placenta praevia Previous breech Uterine anomaly Prematurity
