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35 Cards in this Set

  • Front
  • Back
RSA
Breech Positions
Right Sacrum Anterior
LSA
Breech Positions
Left Sacrum Anterior
SA
Breech Positions
Sacrum Anterior
SP
Breech Positions
sacrum posterior
RST
Breech Positions
Right sacrum transverse
RSP
Breech Positions
Right sacrum posterior
LST
lBreech Positions
Left Sacrum Transverse
LSP
Breech Positions
left sacrum posterior
Breech
Longitudinal lie, presenting part breech, or buttocks, denominator is sacrum
Breech
Incidence
3 to 4 % of pregnancies at term.
25% at 28 weeks, decreasing nearer to term.
Breech
Risk factors
abdominal relaxation, high parity, multiple gestation, preterm labor, hydramnios, oligohydramnios, uterine anomalies, fetal demise, contracted pelvis, hydrocephaly, anencephaly, placenta previa
Breech
symptoms
rib pain, feeling movement in lower abdomen
Breech
Signs
fundal height higher than gestational age, head felt in fundus, breech in pelvis, no cephalic prominence is felt in pelvis, presentng part is high on vaginal exam, FHT MAY be heard above or at umbilicus, Presenting part is soft and irregular
Breech
Complete
Denominator sacrum,
presenting part is fetal pelvis
knees and thighs abducted
Breech
footling
foot presenting part
single or double, extension at knees and thighs
Breech
Frank
Denominator sacrum
presenting part fetal pelvis
thighs abducted
knees extended 66% of breeches are frank
Breech
Kneeling
single or double, extension of thighs and flexion at knees.
Knees are presenting part
Breech
Test
U/S to confirm diagnosis, discover fetal anomalies, measure biparietal diameter, localize placenta, R/O previa
Breech
Complementary Medicine
Slant board, visualization, acupuncture,
Breech
External Cephalic version
Standard of Practice
External version done in presence of U/S to check for fetal position, EFM.
use of medications to diminish contractions, in some hospitals with IV and capability of C-section
Breech
External version
Midwifery Practice
local laws rule
Breech
Mechanisms of Labor
descent: buttocks and lower limbs, shoulders and arms, finally head
Breech
risk to baby
asphyxia, cord prolapse, seizure, coma, death, aspiration of amniotic fluid, fractures, skull fractures, cervical and brachial plexus paralysis, spinal cord injury, liver and internal organ injury
Breech
risk for mother
lacerations, and hemorrhage from rapid birth of the head
Breech
Vaginal exam
labor
presenting part high, presenting part may be soft and irregular, sometimes foot or knee is felt
Breech
Abdominal exam
hard head felt in fundus, soft breech felt in lower abdomen, no cephalic prominence found in pelvis. FHTs may be at or above umbilicus.
Breech
Oxorn Trial of labor
36 to 42 weeks gestation
2500 to 3800g
Frank Breech
Biparietal <9.5cm
not fetal need for c=section
breech score of 4 or >
Breech score
oxorn
includes, parity, gestational age, previous breech >2500, cervical dilatation, station
Breech
Trial of Labor
oxorn
Bedrest
continuous monitoring,
minimize vag exams
leave membranes intact until labor is well advanced.
Breech Trial of labor
oxorn
card 2
vag exam at SROM to R/O cord prolapse
IV of saline
Breech
second stage
oxorn
spontatneus/assisted
Lithotomy (or not as extreme supine)
Monitor FHTs
no interference or handling of the baby until the birth of the body until the umbliicus,
hard bearing down efforts by mother
suprapubic pressure to ensure flexion of hte head
Breech
Midwifery Model of Care
Spontaneous
1 complete dilation with frank breech
2 supine or upright position

3baby born to umbilicus, cord looped down, weight of baby causes traction to head holding it in flexion
4 arms are swept down
5 bear down hard, following the instruction of the midwife
6 as back of neck is visualized, legs are raised, to maintain flexion
7 mentum delivered,face the occiput
Do Not allow the Baby to restitute to Mentum anterior
Breech
Midwifery Model of Care
Preperation
patient instructed to follow midwives instruction exactly
preparation for resuscitation made
Preparation for transport made
Draw up Pitocin
prepare material for suturing
Unexpected Breech
Remain calm
Call 911
If delivery is eminent prepare to resuscitate baby,
Calmly describe the situation to the family.
If there is time discuss transport and possible c-section, and experience
Breech
place fingers inside vagina, find mentum,