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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
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Incidence
Gestation (weeks) % Breech
21 - 24 33%
25 - 28 28%
29 - 32 14%
33 – 36 9%
37 – 40 3-4%
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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
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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
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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)
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