Breech + ECV

Question 1

Most common breech

Answer 1

Frank

65%

Question 2

Least common breech

Answer 2

Complete

5-10%

Question 3

What percentage of babies are breech at 28 weeks

Answer 3

20%

Question 4

What percentage are breech at 32 weeks

Answer 4

16%

Question 5

What percentage are breech at term

Answer 5

3-4%

Question 6

How many breech at 36 weeks convert to Cephalic by term

Answer 6

8%

Question 7

What percentage of breech vaginal births are converted to LSCS

Answer 7

40%

Question 8

Perinatal morbidity and mortality for planned lscs due to breech

Answer 8

0.5 : 1000

Question 9

Perinatal morbidity and mortality planned vaginal breech delivery

Answer 9

2: 1000

Question 10

What percentage of ECV successful

Answer 10

50%

Question 11

How many successful ECV revert to breech by term

Answer 11

3%

Increased in multigravidas

Question 12

Percentage success of ECV in
a) nulliparous
B) multiparous

Answer 12

A) 40%
B) 60%

Overall 50%

Question 13

What gestational age to attempt ECV
a) nulliparous
B) multiparous

Answer 13

A) 36 weeks
B) 37 weeks

Question 14

Incidence of footling breech

Answer 14

10-40%

Question 15

Unfavorable breech factors (7)

Answer 15

• footling or kneeling
• > 3.8kg
• <2kg
• hyperextended fetal neck
• contraindications to vaginal birth
• lack of trained personnel
• previous section (relative contraindication)

Question 16

Risk of cord prolapse with footling breech

Answer 16

15%

Question 17

Risk of cord prolapse with frank breech

Answer 17

0.5%

Question 18

Risk of cord prolapse with cephalic presentation

Answer 18

0.4%

Question 19

Risk of cord prolapse with complete breech

Answer 19

5%

Question 20

Perinatal mortality reduction with planned lscs (elearning)

Answer 20

67% reduction

Question 21

Positive predictors of ecv success (8)

Answer 21

• multiparty
• non engaged breech
• maternal weight <65kg
• tocolysis
• palpable fetal head
• posterior placenta
• complete breech
• afi >10

Question 22

What tocolytic is recommended for use in ECV

Answer 22

Betamimetics

Salbutamol 250mcg in 25ml NS
Terbutaline 250mcg sc

Question 23

What are the negative effects of betamimetics

Answer 23

• palpitations
• tachycardia
• flushing
• tremor
• nausea

Question 24

What are medical contraindications to betamimetics

Answer 24

• cardiac disease
• hypertension
• diabetes

Question 25

Contraindications to ecv(5)

Answer 25

- placenta praevia - multiple pregnancy - rhesus isoimmunization - current or recent APH - ruptured membranes

Question 26

Risk of emergency section in 24hours

Answer 26

0.5%

Question 27

What precautions should be taken for fetal safety with ECV

Answer 27

- performance in facility for monitoring fetus and surgical delivery - standard preoperative investigations are NOT required - FMH testing post procedure if RH D neg

Question 28

How many attempts and time duration is recommended for ECV

Answer 28

- 4 attempts - 10minutes total