Vaginal breech delivery

Question 1

what were the results of the term breech trial? long term follow-up? conclusions?

Answer 1

term breech trial demonstrated in a multicenter rct planned breech deliveries associated with worse neonatal, perinatal morbidity and mortality. long term follow-up slightly less conclusive.

acog says breech delivery can be offered under right circumstances (institution, protocol)

Question 2

Prerequesitives for vaginal breech delivery?

Answer 2

• call for help: additional OB, pediatrician, RN, and anesthesiologist
• piper forceps in room
• empty bladder and rectum
• functional IV
• oxygen for mother

Question 3

process of delivery

Answer 3

1) hands off until neonate is at the umbilicus– no tractional force. assess position of sacrum
2) delivery legs: spontaneously vs pinauds manuever (pressure in popliteal fossa to bend knee)
3) wrap body in moist towel; have mom push to scapula
4) lovset’s manuever: slide hand from back over shoulder onto anterior surfaceo f the humerus, place pressure in cubital fossa and sweep arm over chest to the side and out of the vagina.
5) reapply towel
6) rotate back anteriorly

Question 4

steps if head entrapment?

Answer 4

• episiotomy if indicated
• suprapubic pressure
• bracht manuever - sweep body up (ONLY IF BACK OF NECK FIRMLY TUCKED UNDER SYMPHYSIS)
• durhssen’s incisions (2, 10 and 6 oclock)
• piper forceps
• duhrssens if necessary (2, 10, and 6) -> preferrable to extent into rectum vs bladder; typically only in cases of extreme prematurity.

Question 5

risks of vaginal breech delivery?

Answer 5

• higher risk of fetal death, asphyxia, spine injury, cord prolapse, arrest of aftercoming head

Question 6

checklist prior to vaginal breech delivery?

Answer 6

• anesthesia/IV & OR
• help
• labs/IV
• notify blood bank
• consent patient
• move immediately to emergent CD If possible

Question 7

contraindications to breech delivery

Answer 7

• cord presentation
• footling presentation
• fetal growth restriction
• EFW > 4000 g or < 2500 g
• fetal anomaly
• clinically inadequate pelvis
• hyperflexion of head

Question 8

define brow presentation

Answer 8

presenting part is from anterior fontanelle to orbits

Question 9

define face presentaiton

Answer 9

forehead to to chin is presenting part

Question 10

when can you consider continued trial of vaginal delivery

Answer 10

• if mentum (chin) is anterior - > yes

- if mentum (chen) is posterior -> likely not unless good progress in labor