CBL 9 - Breech

Question 1

What is the biggest risk of malpresentation?

Answer 1

Cord prolapse

Question 2

What is the biggest risk of malpresentation?

Answer 2

Cord prolapse

Question 3

What is malpresentation?

Answer 3

The part that is in the pelvis, ex. Breech, transverse

Question 4

What is malposition?

Answer 4

How the head is positioned, ex OP

Question 5

Factors associated with malpresentation? (6)

Answer 5

• High order parity (pendulous abdomen)
• Contracted pelvis
• Malformations of uterus
• Altered placentation
• Extremes of amniotic fluid (poly or oligo)
• PROM

Question 6

Risks of malpresentation? (7)

Answer 6

• Cord prolapse
• Labour dystocia
• Maternal trauma
• Surgical/instrumental birth
• PPH
• Fetal morbidity
• Perinatal mortality

Question 7

What is the denominator of face presentation?

Answer 7

Mentum

Question 8

Can mentum be born vag?

Answer 8

Yes, if in mentum anterior

Question 9

Can brow be born vag?

Answer 9

No

Question 10

Can shoulder be born vag?

Answer 10

No

Question 11

What are some malpresentations in labour?(6)

Answer 11

• Face,
• brow,
• breech,
• shoulder,
• compound cord
• unstable lie

Question 12

How common is breech?

Answer 12

3-4 %

Question 13

What is the most feared outcome of vag breech birth?

Answer 13

Entrapment

Question 14

What are the types of breech presentation?

Answer 14

• Frank
• complete
• footling

Question 15

What is frank breech?

Answer 15

Buttocks in pelvis with hips flexed, knees extended, feet toward had
Most favourable for breech vag birth

Question 16

What is complete breech?

Answer 16

Fetal buttocks in pelvis with both hips and knees flexed.
Squatting, sitting cross legged

Question 17

What is footling breech?

Answer 17

Fetal hips are deflexed and both or one knee is extended resulting in both/one foot presenting.
Not favourable for vag birth
More likely for prolapsed cord and irregular dilating surface, fetal entrapment

Question 18

Contraindications for ECV? (9)

Answer 18

• C/S birth indicated
• Antepartum hemorrhage in last week
• Ab EFM
• Major uterine anomly
• Multiple pregnancy
• Preclampsoa
• Small for GA, ab dopplers
• Oligo
• Major fetal anomolies

Question 19

Success rate for ECV?

Answer 19

30 % nulips
58% multips

Question 20

What should be done prior to an ECV?

Answer 20

Rh immunoglobulin if indicated
NST

Question 21

Complications of ECV? (5)

Answer 21

Short term FHR decel common complication post ECV

Less common:
* fracture of fetal leg bones,
* ROM,
* placental abruption,
* feto-maternal hemmorhage

Question 21

How does IFHB work?

Answer 21

• Managed through Medavie Blue Cross (MBC)
• It’s a (seemingly) simple online or mailed form to sign up
• Works similarly to MSP
• Once approved you submit through MBC’s online platform for reimbursement
  For people with refugee status

Question 22

Does IFHB apply to newborns?

Answer 22

No, they are citizens so have MSP

Question 23

What could Thalassemia look like on a CBC?

Answer 23

RBC N Hb Low MCV Low MCH Low Ferritin Normal high

Question 24

What kind of disorder is thalassemia?

Answer 24

Autosomal recessive

Question 24

Who more likely to be a carrier of thalassemia? (5)

Answer 24

Sub-Saharan African Middle Eastern Meditaranian Indian East/Southeast Asian

Question 25

What is Bart’s disease?

Answer 25

4 /4 thalassemia genes – hydrops incompatible with life

Question 26

What is the chance of 2 carriers of thalassemia having a babe with Bart’s disease?

Answer 26

25 %

Question 27

What is sickle cell disease?

Answer 27

* Homozygous SS disease – autosomal recessive inherited disorder where hemoglobin S is produced instead of hemoglobin A. (1) * Red blood cells (RBCs) form a moon/sickle shape making them less able to bend to travel through blood vessels, are more adhesive and more likely to clump together (1)

Question 28

Sickle cell disease most common?

Answer 28

Black African American, but also Mediterranean, India, Middle East, sub-Saharan Africa

Question 29

Sickle cell disease in pregnancy?

Answer 29

Maternal * Raised metabolism (2) * Higher hormones that raise risk of blood clots (2) * Serious anemia (2) * Increased pain crises (2) * Increased risk of dying in pregnancy or postpartum (2) * Higher risk of serious diseases caused by sickle cell disease (2) * High blood pressure (2) * Venous thromboembolism (2) * Preeclampsia (2) * UTIs (2) Fetal * Miscarriage (2) * Preterm birth (2) * Low birth weight (2) * IUGR (2) * Stillbirth (2)

Question 30

Sickle cell train in pregnancy?

Answer 30

Usually asymptomatic: Genetic counselling, increase incidence of UTIs, lessen accuracy of Hb A1C testing. Offer urine culture every trimester.