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25 Cards in this Set
- Front
- Back
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Describe the lie of the foetus
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The relationship of the fetus the long axis of the uterus
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Longitudinal lie means the presentation will be
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cephalic or breech
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Describe the other forms of lie
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Oblique -Head in the iliac fossa Transverse - head in the flank |
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Abnormal lie occurs in what percentage of pregnancies
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One in 200 however earlier it is more common and as normal
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Described risk factors for abnormal lie
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Polyhydramnios
Greater parity Also conditions that prevent turning such as multiple pregnancy and baby abnormalities Conditions that prevent engagement such as placenta praevia or uterine deformities |
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Management of abnormal lie (abnormal lie means transverse or oblique)
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No action before 37 weeks unless the Woman is in labour
After 37 weeks the woman is usually admitted in case of preterm rupture of membranes or preterm labour and an ultrasound scan is performed to exclude risk factors such as polyhydramnios and placenta praevia |
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When is the mother discharged for abnormal lie
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If the baby goes into spontaneous version and this persists for more than 48 hours
If the uterus is normal or not obstructed abnormal libel usually fix itself by 41 weeks |
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Is the baby has not spontaneously verted then how is it delivered
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Via Caesarian section or in
Expert hands ECV and amniotomy |
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How is breech presentation classified
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Based upon the part of the baby that occupies the lower segment of the uterus when it is the buttocks
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How common is breech presentation
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3% but more common earlier on in pregnancy up to 25% |
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Describe variations of breech presentation
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70% extended breech both legs extended at the knee but flexed at the hip 15% flexed where the legs are flexed at the knee 15% footling breech where the legs are flexed at the knee and the feet present below the buttocks (more common in preterm) |
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Breech presentation is only important from what point |
From 37 weeks onwards or if the patient is in labour
30% of breach deliveries missed |
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Describe complications of breach delivery
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Higher rate of neurological handicap
Poor fit leads to increased rate of cord prolapse Crackhead |
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Wat management of breach presentation begins at 37 weeks
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External cephalic version
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Describe the advantages of external cephalic version and the success rate
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Advantage is that there's less breech presentation at term and therefore Caesarian or vaginal breech delivery is reduced
Success rate is about 50% 3% successfully turned will turn back If external cephalic version fails only 3% will then turn spontaneously |
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Technique of external cephalic version
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Administer uterine relaxant (tocolytic)
Disengage from the pelvis by pushing operas until side in order to form a forward somersault Performed under ultrasound guidance and in-hospital CTG is perform straight after Anti D is given to rhesus negative women |
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Factors that affect the success of ECV
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Less success in nulliparous women
Caucasians Engaged bridge Hi uterine tone Liquor volume Obesity Fetal size makes little difference |
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What is the risk of immediate emergency Caesarian section due to failure of external cephalic version
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Nought .5%
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Name some contraindications to external cephalic version
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If foetuses compromised
A vaginal delivery would be compromised in anyway four example placenta praevia Twins If the membranes ruptured Recent antepartum haemorrhage |
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Caesarian section with regards to preach delivery
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Caesarian section is the safest method of delivery for the Singleton term breach
or ECV has failedor is contraindicated or if the breach presentation was missed |
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What percentage of vaginal breech deliveries end in Caesarian section
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One third more than
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Vaginal breech delivery it Is more dangerous if foetuses over what size
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4 kg or
Evidence of fetal compromise Or extended head Or footling legs |
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When is pushing encouraged in breach delivery and intrapartum care to consider
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When the buttocks are visible
CCG's advice Epidural is common but not required Often cervical dilation is delayed (30%) and the second stage of labour is slow especially descent |
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Describe how to deliver baby in breach position
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Buttocks distended perineum
episiotomy made Flex the legs out of the vagina Hook Each arm out Lovset's corkscrew may need to be performed if no arms With the weight of the foetus supported in one hand the head is guided out with your fingers in his mouth over the perineum maintaining flexion the other hand presses against the occiput to deliver the head |
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If you head fail to come out using the mauriceau method what can be used
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Forceps whilst the assistant holds the legs of the child
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