Malposition & Malpresentation

Question 1

How do breech presentations change during pregnancy?

Answer 1

25% of babies are beech at 28 weeks, this changes to 3% at term

Question 2

Risk factors for breech?

Answer 2

Uterine malforatiom
Fibroids
previous uterine surgery
placenta praevia
hydramnios
multiple pregnancy
prematurity

Question 3

what issue is more common in breech?

Answer 3

cord prolapse

Question 4

3 types of breech?

Answer 4

FRANK most COMMON

Question 5

What is a unstable lie?

Answer 5

Transverse lie

80% revert to longituidinal lie before labour

Traverse lie increases risk of cord prolapse (same way breech ppt does)

Question 6

Clinical features of breech ppt?

Answer 6

palpable head at fundus, soft breech in pelvis.

Question 7

Transverse lie baby on examination

Answer 7

uterus appears wide, fundal height may be low, no presenting part in pelvis.

Question 8

If membranes have not yet ruptures and baby is at transverse lie - what xan be done?

Answer 8

ECV

Question 9

If baby is still breech at 36 weeks?

Answer 9

ECV - external cephalic version

US before and after + CTG monitoring

nullip = 36 weeks
multip = 37 week

Question 10

If ECV fails for breech pregnancy 2nd line?

Answer 10

Elective C section

• can consider doing vaginal breech delivery by 40% ends up EMCS

Question 11

What is an absolute contraindication to vaginal breech delivery?

Answer 11

Footling breech

Question 12

C/I to doing an ECV?

Answer 12

antepartum haemorrhage in last 7 days, abnormal CTG, ruptured membranes, multiple pregnancy, major uterine abnormality, other reason for caesarean section.

Question 13

ECV success rate?

+ risks

Answer 13

50% success

1/200 risk of EMCS - foetal distress

Question 14

Medication to consider when doing ECV?

Answer 14

Anti-D if woman in rhesus negative

Tocolytic agent e.g. terbutaline can improve success rate by relaxing uterus

Question 15

How to manage transverse lie?

Answer 15

C section if membranes have ruptured