list RF for breech
prematurity/SGA, polyhydramnios, multiple, placenta praevia
what signs indicate breech?
fetal head palpable in fundus and buttocks palpable below umby, FHR auscultated above umby
describe ECV and criteria
external cephalic version aims to turn baby from breech to cephalic w manual manipulation of position, attempted between K36-38 where fetus is not engaged
compare the types of breech
frank: hips flexed and legs extended into abdo, safest for VB
complete: hips and knees flexed, presents w buttocks first
footling: one or both feet present as neither hips nor knees fully flexed
best practice during labour w breech baby?
encourage woman to remain upright and mobile to aid in descent of buttocks and dilation of cx
what is incidence of breech at term?
<5%
what situations may follow breech that also need management and how to prepare?
fetal hypoxia: paeds and exp staff aware and present
head entrapment: senior clinicians present, prep for instrumental
cord prolapse: be aware as presenting part not fixed to cx, theatres aware
PPH: active management, fluids, OB aware
describe the management of breech birth
hands off the breech, should be birth by propulsion not traction, guard peri as legs birth to try reduce tearing, allow baby to birth until scapula visible = loveset manoeuvre and birth of arms, then smelly-veit w baby on forearm and fingers on cheeks other hand on occiput to ensure head flexion, deliver in J shape
why is breech a hands off approach?
to ensure fetal head does not extend to de-flexed position
