abnormal laborhums.ac.ir/uploads/breech_presentation_class_2.pdf · 2018-03-04 · abnormal labor o...

Abnormal Labor

o Abnormalities of the expulsive force

o Abnormalities of the maternal bony pelvis- that is, pelvic contraction

o Abnormalities of presentation, position, or development of the fetus

o Abnormalities of soft tissues of the reproductive tract

Abnormal Labor

ACOG simplified these abnormalities to:

o Abnormalities of the powers (uterine contractility and maternal expulsive effort)

o Abnormalities of the passage (the pelvis)

o Abnormalities of the passenger (fetus)

BREECH PRESENTATION

5

Incidence

Gestation (weeks) % Breech

21 - 24 33%

25 - 28 28%

29 - 32 14%

33 – 36 9%

37 – 40 3-4%

6

causes

oکم بودن سن جاملگی

o حجم غیر طبیعی مایع آمنیون

oجاملگی چند قلویی

oهیدروسفالی

oآننسفالی

oناهنجاریهای رحم

o النه گزینی جفت در فوندوس

oتومورهای لگن

o پاریتی زیاد همراه با شلی رحم

o سابقه زایمان بریچ

oسابقه زایمان سزارین

oپالسنتا پرویا

Types of breeches

Frank breech (70%) - Hips flexed, knees extended

Complete breech (5%) - Hips flexed, knees flexed

Footling or incomplete (25%) - One or both hips extended, foot presenting

Longitudinal lie. Frank breech

presentation.

I

I

Longitudinal lie. Complete breech

presentation.

Longitudinal lie. Incomplete, or footling,

breech presentation.

Strangazer - flying

5 درصد

زایمان واژینال ممکن است سبب .آسیب دید گی نخاع گردنی شود

اندیکاسیون سزارین

DIAGNOSIS

Palpations

Pelvic exam

X-ray studies

Ultrasound

عوارض زایمان

پروالپس بند ناف

آسیب بافت نرم

آسیب نخاع

دیس پالزی هیپشایع تر از نمایش

.سفالیک

پارگیهای دستگاه تناسلی

آتونی رحم

زایمان پره ترم

افزایش ناهنجازیهای مادرزادی

شکستگیهایهومروس،کالویکول و

فمور

15

Vaginal Breech Contraindications

CPD Macrosomia IUGR Footling breech Hyperextension of fetal head Preterm (GA26-34w) non-progressive labour Uterus dysfanction C/S request P. C/S poor history prinatal mortality history Fetal distress ,PROM Fetal anomaly Lack of birth attendant skills

Criteria for VD

VD Frank

GA>34w

weight

Adequate pelvis

Flexed head

Nonviable fetus

Good progress labor

اداره زایمان واژینال بریچ

حضور کادر مجرب

انجام سونوگرافی یا رادیو گرافی

تخمین وزن جنین

پایش مداوم قلب جنین

کاهش تعداد دفعات معاینه واژینال

خودداری از پارگی کیسه آب تا مرحله دوم

تخلیه مثانه

منع زائو از زور زدن

VAGINAL BREECH DELIVERY

Three types of vaginal breech deliveries:

o Spontaneous breech delivery o Assisted breech delivery o Total breech extraction

Copyright Lynne Staff Oct 2007 20

http://www.emedicine.com/cgi-bin/foxweb.exe/makezoom@/em/makezoom?picture=/websites/emedicine/med/images/Large/2383IMG004.jpg&template=izoom2

Assisted vaginal breech delivery: After the scapula is reached, the fetus should be rotated 90° in

order to delivery the anterior arm.



Assisted vaginal breech delivery: The anterior arm is followed to the elbow, and the arm is swept out of the vagina.



Assisted vaginal breech delivery: The infant is then rotated 90° to the back-up position in preparation for

delivery of the head.



Assisted vaginal breech delivery: The fetal head is maintained in a flexed position by using the Mauriceau-Smellie-Veit maneuver, which is performed by placing the index and middle fingers over the maxillary prominence on either side of the nose. The fetal body is supported in a neutral position with care to not overextend the neck.



Mauriceau- technique with fundal)

(Pinard’s manoeuvre)

Nuchal position in breech delivery

Arrest of the after-coming head with the occiput posterior (Prague’s manoeuvre)

abnormal laborhums.ac.ir/uploads/breech_presentation_class_2.pdf · 2018-03-04 · abnormal labor o...

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