document20
TRANSCRIPT
![Page 1: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/1.jpg)
BREECH PRESENTATION BREECH PRESENTATION & &
DELIVERYDELIVERY
PanwadPanwad RattanasrithongRattanasrithong INT2INT2
![Page 2: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/2.jpg)
Definition & Clinical Definition & Clinical importanceimportance
![Page 3: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/3.jpg)
DefinitionDefinition
The presentation that the fetus is in The presentation that the fetus is in longitudinal lie and its buttock enter the longitudinal lie and its buttock enter the pelvis firstpelvis first
![Page 4: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/4.jpg)
IncidenceIncidence
33--4% of singleton deliveries4% of singleton deliveries15% at 29 15% at 29 –– 32 weeks32 weeks
![Page 5: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/5.jpg)
ETIOLOGYETIOLOGYPrecipitating factorPrecipitating factor
Gestational ageGestational ageGreat parity / Multiple fetuses (uterine Great parity / Multiple fetuses (uterine relaxation)relaxation)HydramniosHydramnios / / OligohydramniosOligohydramniosHydrocephalus / Hydrocephalus / AnencephalusAnencephalusPrevious breech deliveryPrevious breech deliveryUterine anomalies / Pelvic tumorsUterine anomalies / Pelvic tumorsPlacenta Placenta previaprevia
![Page 6: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/6.jpg)
Types of breechTypes of breech
![Page 7: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/7.jpg)
Types of breech Types of breech Frank breechFrank breech : flexed at hips and : flexed at hips and extended at kneesextended at kneesComplete breechComplete breech : flexed at hips and : flexed at hips and flexed at kneesflexed at kneesIncomplete breechIncomplete breech : one or both hips : one or both hips are not flex and one or both feet or knees are not flex and one or both feet or knees lie below the breechlie below the breech
![Page 8: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/8.jpg)
![Page 9: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/9.jpg)
![Page 10: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/10.jpg)
DiagnosisDiagnosis
![Page 11: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/11.jpg)
AbdominalAbdominal examinationexamination
11stst Leopold maneuver: ballottementLeopold maneuver: ballottement
22ndnd Leopold maneuver: large partLeopold maneuver: large part33rdrd Leopold maneuver: movableLeopold maneuver: movable44thth Leopold maneuver:Leopold maneuver: prominenceprominence
![Page 12: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/12.jpg)
Vaginal ExaminationVaginal Examination
Palpable : both Palpable : both ischialischial tuberosities,thetuberosities,thesacrum and the anus sacrum and the anus DDxDDx : Face presentation (Mouth and : Face presentation (Mouth and MalarMalar eminence)eminence)Position & Variety : Position & Variety : Sacrum&SpinusSacrum&Spinusprocessprocess
![Page 13: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/13.jpg)
Imaging TechniquesImaging Techniques
UltrasoundUltrasoundCTCTMRIMRI
![Page 14: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/14.jpg)
Mechanism of deliveryMechanism of delivery
![Page 15: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/15.jpg)
Mechanism of deliveryMechanism of delivery
Denominator Denominator
![Page 16: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/16.jpg)
Mechanism of deliveryMechanism of delivery
Engagement Engagement Descent Descent Internal rotationInternal rotationLateral flexionLateral flexionExternal rotationExternal rotationBirth : breech Birth : breech body body headhead
![Page 17: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/17.jpg)
Mechanism of deliveryMechanism of delivery
Engagement
Descent
![Page 18: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/18.jpg)
Mechanism of deliveryMechanism of delivery
Internal rotation Lateral flexion
![Page 19: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/19.jpg)
Mechanism of deliveryMechanism of delivery
External rotation Birth : breech
![Page 20: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/20.jpg)
Mechanism of deliveryMechanism of delivery
Birth : body head
![Page 21: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/21.jpg)
Modes of deliveryModes of delivery
![Page 22: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/22.jpg)
Modes of deliveryModes of delivery
Cesarean sectionCesarean sectionVaginal deliveryVaginal delivery
Spontaneous breech deliverySpontaneous breech deliveryAssisted breech deliveryAssisted breech delivery(Partial extraction)(Partial extraction)Total breech extractionTotal breech extraction
![Page 23: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/23.jpg)
Vaginal deliveryVaginal delivery
![Page 24: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/24.jpg)
Vaginal deliveryVaginal deliveryEntrapment of fetal head : Entrapment of fetal head : DuhrssenDuhrssen
incision incision Entrapment of fetal arm behind the neck Entrapment of fetal arm behind the neck
((nuchalnuchal arm)arm)ProlapseProlapse cord : complete cord : complete –– 5% ,footling5% ,footling--
15%15%
![Page 25: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/25.jpg)
DuhrssenDuhrssenincision incision
![Page 26: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/26.jpg)
Vaginal deliveryVaginal deliveryUnfavorable pelvisUnfavorable pelvis
GynecoidGynecoid & anthropoid : favorable& anthropoid : favorablePlatypelloidPlatypelloid & Android : unfavorable & Android : unfavorable
![Page 27: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/27.jpg)
Vaginal deliveryVaginal delivery
Hyperextension Hyperextension 5 % in term breech presentation5 % in term breech presentationResult : Injury to C spinal cordResult : Injury to C spinal cordMarked hyperextension : C/SMarked hyperextension : C/S
![Page 28: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/28.jpg)
Vaginal deliveryVaginal delivery
Labor induction & AugmentationLabor induction & AugmentationNo significant mortality and No significant mortality and ApgarApgar
between infant with induced between infant with induced vsvs spontanousspontanous]]OxytocinOxytocinAmniotomyAmniotomyCT confirm adequate pelvisCT confirm adequate pelvis
![Page 29: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/29.jpg)
Vaginal deliveryVaginal deliveryManagement of laborManagement of labor
Establish : Establish : Membranes,labor,FetalMembranes,labor,Fetalcondition,UCcondition,UC
Notified nurseryNotified nurseryStage of Labor : Stage of Labor : CxCx , , EffEff , Station ,Presentation , Station ,Presentation Fetal Monitoring : Fetal Monitoring :
FHR q 15 min (most continue EFM)FHR q 15 min (most continue EFM)PV check cord PV check cord prolapseprolapse & FHR q 5& FHR q 5--10min (MR)10min (MR)
![Page 30: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/30.jpg)
Vaginal deliveryVaginal delivery
Methods of Vaginal deliveryMethods of Vaginal deliverySpontaneous breech deliverySpontaneous breech deliveryPartial breech extractionPartial breech extractionTotal breech extraction Total breech extraction
![Page 31: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/31.jpg)
Vaginal deliveryVaginal delivery
Assisted Breech DeliveryAssisted Breech Delivery
![Page 32: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/32.jpg)
Vaginal deliveryVaginal delivery
The posterior hip of frank breech is delivering
![Page 33: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/33.jpg)
Vaginal deliveryVaginal delivery
The anterior hip has now delivered and external rotation has occurred. The fetal thighs remain in flexion with extension knees.
![Page 34: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/34.jpg)
Mode of Mode of deliverydelivery
Delivery of theDelivery of thelegslegs by placing by placing the fingers the fingers parallel with parallel with medial aspect of medial aspect of the femur and the femur and displacing displacing laterally and away laterally and away from midlinefrom midline
![Page 35: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/35.jpg)
Mode of Mode of deliverydelivery
Delivery of the body.Delivery of the body.
![Page 36: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/36.jpg)
Delivery of the shoulderDelivery of the shoulder
Cats paw methodCats paw methodClassical methodClassical methodLovsetLovset ‘‘s methods method
![Page 37: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/37.jpg)
Cats paw methodCats paw method
![Page 38: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/38.jpg)
Cats paw methodCats paw method
![Page 39: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/39.jpg)
Classical Classical MethodMethod
![Page 40: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/40.jpg)
LovsetLovset’’ss MethodMethod
![Page 41: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/41.jpg)
Partial breech extraction or Partial breech extraction or breech assistingbreech assisting
Delivery of the Delivery of the aftercomingaftercoming headheadMauriceauMauriceau--SmellieSmellie--veitveit maneuvermaneuverPrague maneuverPrague maneuverPiper forcepsPiper forceps
![Page 42: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/42.jpg)
MauriceauMauriceau--SmellieSmellie--VeitVeit ManeuverManeuver
![Page 43: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/43.jpg)
Prague maneuverPrague maneuver
The back of the The back of the fetus fail to fetus fail to rotate to the rotate to the anterioranterior
![Page 44: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/44.jpg)
Piper ForcepsPiper Forceps
![Page 45: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/45.jpg)
Total breech extractionTotal breech extraction
IndicationIndication1. Prolong second stage of labor1. Prolong second stage of labor2. Twin2. Twin3. Maternal disease3. Maternal disease4. 4. ProlapseProlapse cordcord5. Fetal distress5. Fetal distress
![Page 46: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/46.jpg)
Total breech extractionTotal breech extraction
ContraindicationContraindication1. Cervix not fully dilated1. Cervix not fully dilated2. CPD2. CPD
![Page 47: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/47.jpg)
Total breech extractionTotal breech extraction
The hand is introduced through the vagina The hand is introduced through the vagina &both feet of the fetus are grasped&both feet of the fetus are graspedGentle traction the feet through the vulvaGentle traction the feet through the vulvaBreech appears at the vulva, gentle Breech appears at the vulva, gentle traction until the hips are deliveredtraction until the hips are deliveredassisted breech delivery assisted breech delivery
![Page 48: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/48.jpg)
Complete Complete breech breech extraction extraction begins with begins with traction on the traction on the feet and anklesfeet and ankles..
![Page 49: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/49.jpg)
continues with continues with traction on the traction on the thighsthighs
![Page 50: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/50.jpg)
the scapulas the scapulas becomes becomes visible and the visible and the body rotates, body rotates, usually to the usually to the side of the side of the mother mother
![Page 51: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/51.jpg)
Cesarean sectionCesarean section
RecommendationRecommendationLarge fetusLarge fetusContraction or unfavorable shape of pelvisContraction or unfavorable shape of pelvisHyperextendedHyperextended headheadDelivery is indicated but not in laborDelivery is indicated but not in laborUterine dysfunctionUterine dysfunctionIncomplete or footling presentationIncomplete or footling presentation
![Page 52: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/52.jpg)
Cesarean sectionCesarean section
RecommendationRecommendationHealthy preterm Healthy preterm Severe fetal growth restrictionSevere fetal growth restrictionPrevious Previous perinatalperinatal death or newborn death or newborn complication of birth traumacomplication of birth traumaA request for sterilizationA request for sterilizationLack of an experienced operatorLack of an experienced operator
![Page 53: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/53.jpg)
Morbidity & MortalityMorbidity & Mortality
Maternal InjuriesMaternal InjuriesRisk : Operative interventionRisk : Operative interventionManipulations : Risk infectionManipulations : Risk infectionIntrauterine maneuvers : Rupture of the Intrauterine maneuvers : Rupture of the
uterus +/uterus +/-- lacerations of lacerations of CxCxExtensions of the episiotomy Extensions of the episiotomy Uterine Uterine atonyatony , Postpartum hemorrhage, Postpartum hemorrhage
![Page 54: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/54.jpg)
Morbidity & MortalityMorbidity & MortalityPerinatalPerinatal Morbidity & MortalityMorbidity & Mortality
Preterm delivery & low birth weight & IUGRPreterm delivery & low birth weight & IUGRProlapseProlapse cordcordBirth Birth aphyxiaaphyxiaFetal InjuriesFetal Injuries
FxFx of of humeroushumerous and clavicleand clavicleFxFx of femurof femurHematomasHematomas of of sternocleidomastoidsternocleidomastoidSeparation of epiphyses of Separation of epiphyses of scapular,humerusscapular,humerus or femuror femurBrachial plexusBrachial plexusAvulsion of upper CAvulsion of upper C--spinespineSkull Skull FxFx , , intracerebralintracerebral injuryinjury
![Page 55: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/55.jpg)
IntracerebralIntracerebral haemorrhagehaemorrhage
![Page 56: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/56.jpg)
Birth asphyxiaBirth asphyxia
![Page 57: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/57.jpg)
VersionVersion
![Page 58: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/58.jpg)
VersionVersion
External cephalic versionExternal cephalic versionInternal Internal podalicpodalic versionversion
![Page 59: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/59.jpg)
External Cephalic VersionExternal Cephalic Version
![Page 60: Document20](https://reader033.vdocuments.us/reader033/viewer/2022052823/5556eb73d8b42a0f028b5043/html5/thumbnails/60.jpg)
Thank you for attentionThank you for attention