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53 Cards in this Set
- Front
- Back
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Define lie |
The relationship of the long axis of the fetus to that of the maternal spine |
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What percentage of the fetus takes a permanent longitudinal lie at term |
99% |
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Types of lie |
Longitudinal Oblique Transverse |
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What is unstable lie |
When the fetus continues to change lie at term |
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Management of unstable lie |
Stabilizing induction if there is no contraindication to vaginal delivery |
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Management of oblique lie |
If it doesn't correct to longitudinal with strong uterine contraction in labour, deliver by C/S |
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Delivery option in transverse lie |
•Dead fetus & very small preterm fetus: vaginally by double folding •Viable fetus: caesarean section |
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Define presenting part |
The part of the fetus that is in contact with the maternal pelvis |
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Define presentation |
The part of the presenting part felt during V.E |
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Presenting part in transverse lie |
Shoulder |
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Normal presentation |
Vertex |
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Abnormal presentation |
Breech, brow, face, cord, compound |
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Percentage of vertex presentation at term |
96% |
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Percentage of breech presentation at term |
3% |
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Percentage of face and shoulder presentation at term |
0.5% |
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Presenting diameters in vertex presentation |
Suboccipitofrontal diameter (10cm) & biparietal diameter (9.5cm) |
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Presenting diameters in brow presentation |
Mentovertical (13.5cm) & biparietal (9.5cm) |
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Presenting diameters in brow presentation |
Mentovertical (13.5cm) & biparietal (9.5cm) |
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Presenting diameters in brow presentation |
Mentovertical (13.5cm) & biparietal (9.5cm) |
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The biggest diameter of the pelvis |
12.5cm |
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Presenting diameters in face presentation |
Submentobregmatic (9.5cm) & biparietal (9.5cm) |
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What determines the route of delivery in face presentation |
The leading part. If the mentum leads, delivery by SVD is possible. If the sinciput leads, delivery by SVD is not possible unless the baby is small and the pelvis is roomy |
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Breech presentation |
When either the buttocks or the foot/feet of the fetus occupy the lower uterine segment |
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Types of breech presentation |
1. Frank (extended) breech 2. Complete (Flexed) breech 3. Footling (incomplete) breech |
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Commonest type of breech |
Frank. 65%; commoner in primigravida |
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Risk factors for breech presentation |
•uterine anomalies (septate, bicornuate) •placenta praevia •uterine fibroids •pelvic tumours •multiple pregnancy •oligohydramnios •polyhydramnios •fetal malformations •contracted pelvis •prematurity •multiparity |
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Where can you best hear fetal heart sound in breech presentation |
Above the umbilicus |
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Investigation to confirm breech presentation |
Ultrasound scan |
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Management of preterm breech |
•if no labour - expectant •if in labour - consider salvage rate of the locality. If G.A is capable of surviving do C/S, if not allow vaginal delivery |
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Management of term breech delivery |
A. If there is no associated complications •External cephalic version •Vaginal breech delivery B. If there is associated complications •Elective caesarean section |
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Define external cephalic version |
This is the trans-abdominal manipulation of a breech presenting foetus to a cephalic presentation |
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When is ECV done |
At term (37 weeks) |
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Advantages of ECV |
•Reduces incidence of c/s •Reduces the fetal mortality associated with vaginal breech delivery •Reduces fetal complications associated with vaginal breech delivery |
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Requirements for ECV |
•Facilities for emergency c/s •Skilled personnel •Availability of USS •Availability of CTG |
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Factors that favour ECV |
•Multiparity •Adequate liquor volume •Station of the breech above the pelvic brim •Relaxed uterus (tocolytics) |
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Contraindications to ECV |
Relative: IUGR, HBP, DM, obesity, grand multiparity, anterior placenta, rhesus iso-immunization Absolute: multiple pregnancy, APH, previous c/s, ROM oligohydramnios, major fetal anomaly, contracted pelvis |
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Complications of ECV |
•Abruptio placenta •Membrane rupture •Cord accidents •Premature contraction •Uterine rupture •Fetal distress |
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Types of vaginal breech delivery |
•assisted vaginal breech delivery •breech extraction |
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Conditions for vaginal breech delivery |
•Adequate pelvis (do PA at 36 weeks) •Normal sized fetus (</= 3.5kg, do USS at 36 weeks) •Skilled personnel •Healthy patient that does not have any diseases that will not allow her push during second stage of labour •Absence of footling breech |
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What causes entrapment of the after-coming head |
Where there is incomplete dilatation of the cervix as in footling breech |
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Favourable conditions for successful vaginal breech delivery |
•Skillful personnel •Fetal weight <3.5kg •Multiparty •Previous successful vaginal breech delivery •Previous large babies delivered vaginally •Frank breech •Good labour progress |
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What is the favoured method for vaginal breech delivery |
Assisted vaginal breech delivery |
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Indications for breech extraction |
•Retained second twin in breech or transverse lie •IUFD in breech •Cord prolapse with fully dilated cervix in breech presentation |
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Maternal effort is needed in breech extraction T/F |
False. Complete takeover of delivery |
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Requirements for assisted vaginal breech delivery |
•Experience personnel •Lithotomy position •Analgesia esp epidural block to prevent premature bearing down and allows controlled delivery of the after-coming head |
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What are the stages where assistance is needed in assisted vaginal breech delivery |
•Delivery of the buttocks •Delivery of the legs •At the level of the cord •Delivery of the arms •Delivery of the after-coming head |
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What assistance is given in delivery of the buttocks |
Episiotomy when buttocks distend the perineum |
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What assistance is given in delivery of the legs |
1. Flexed legs: They deliver spontaneously if flexed, or eased out by the assistant 2. Extended legs: Pinnard's maneuver. Back of the baby should be maintained facing superiorly |
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What assistance is given in assisted vaginal breech delivery at the level of the cord |
When the umbilicus becomes visible, a loop of the cord is eased down to avoid compression and avulsion |
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What assistance is given in delivery of the arms |
1. If extended - Lovset's maneuver 2. If flexed - the assistant places the right index finger on the fetal right shoulder and by a gentle downward sweep reaches the cubital fossa to hook the forearm down |
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What assistance is given in delivery of the after-coming head |
Starts when the nape of the neck (hair-line) becomes visible. Can be achieved •use of forceps - pipers. Protects the unmoulded head and controls the speed of descent of the head •Mauriceau-smellie-veit maneuver •Burns Marshall maneuver |
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What is used to protect the head of the preterm breech during delivery of the head |
Piper's forceps. Prevents sudden compression & decompression of the head which causes ventricular hemorrhage |
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What system is used in assessing unbooked breech in labour |
Zatuchni-Andros prognostic scoring system. The higher the score the better the prognosis Parameters used (score of 0-2) are: •parity: Grav 1; Multiparous; ** •GA in weeks: 39; 38; </= 37 •EFW: >3.5kg; **; ** •hx of previous breech delivery: none; 1; >/=2 •dilation: 2cm; 3cm; >/= 4cm •station: >/= -3; -2; </= -1 |
