MRCOG - Part 2 > Breech + ECV > Flashcards

Breech + ECV Flashcards

(39 cards)

Study These Flashcards
1
Q

incidence of breech

A

20% at 28 w
3-4% at term

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2
Q

most common breech type

A

frank breech 65-70%

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3
Q

risks and benefits of planned CS in breech

A

Less:
* still birth >39w
* intrapartum risk
* risks of vaginal breech birth

risk:
* VBAC
* complication in future pregnancies
* repeat CS
* risks of MAP

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4
Q

perecentage of needing emergency CS in breech planning vaginal birth

A

40%

Cs after ECV: 0.5%

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5
Q

high risk planned vaginal breech birth if

A
  1. hyperextended neck by us
  2. fetal weight >3.8 kg
  3. low EFW <10th centile
  4. footling presentation
  5. antenatl fetal compromise
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6
Q

Breech at term may be not diagnosed until labor in what percent

A

25%

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7
Q

epidural analgesia and breech

A
  • may inc risk of intervention
  • if given and contraction <4/10 -> consider oxytocin
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8
Q

if breech isn’t visible within 2h of passive 2nd stage

A

recommend CS

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9
Q

the 2nd twin is non cephalic in how many twin preg

A

40%

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10
Q

success rate of ECV

A

50%
MP: 60%
NP: 40%

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11
Q

rate of spontaneous version from breech to cephalic in PG after 36%

A

8%

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12
Q

spontaneous version from breech to cephalic after failed ECV

A

3-7%

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13
Q

spontaneous rebreech after succeful ECV is

A

3%

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14
Q

when to offer ECV in PG or MP

A

PG: 36w
MP: 37w

don’t do in case of ROM

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15
Q

is ECV after CS safe

A

yes

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16
Q

rh -ve women going to have ECV shall take

17
Q

do tocolysis has any role in ECV

Study These Flashcards
A

tocolysis w/ beta memtics improves the success rates of ECV

18
Q

do we give routine analgesia to women having ECV

Study These Flashcards
A

No, but if: repeat attempt or woman unable to tolerate it

19
Q

absolute CI of ECV

Study These Flashcards
A
  1. when CS is required
  2. APH within last 7 d
  3. abnormal CTG
  4. ROM
  5. major uterine anomaly
  6. multiple pregnancy (except delivery of 2nd twin)
20
Q

Relative CI of ECV

Study These Flashcards
A
  1. SGA + abnormal doppler
  2. PET
  3. Oligo
  4. major fetal anomaly
  5. scarred uterus
  6. unstable lie
21
Q

complications of ECV

Study These Flashcards
A
  • abruption
  • uterine rupture
  • fetomaternal hmge
22
Q

maximum number of ECV attempts

Study These Flashcards
A

no more than 4 attempts for max of 10 mins overall

23
Q

if failed ECV attempt without tocolysis

Study These Flashcards
A

consider using tocoloysis in 2nd attempt

24
Q

percent of breech delivered vaginally

25
IOL and augmentation in breech
IOL: not recommended augmentation: only if contractions are low w/ epidural analgesia
26
best position for breech vaginal delivery
semi recumbent or all fours position
27
time interval allowed between delivery of buttocks and shoulders
2 mins
28
when to intervene during vaginal breech delivery
- if evidence of poor fetal condition - delay >5 min bet buttocks and head - delay >3 min from umbilicus to head
29
when the arms are in front of fetal head what maneauvre to use
Lovset's maneauvre
30
what is burn marshall method
- baby let hanged until nape of the neck is visible: to allow head flexion - then fetal trunk swept towards maternal abd. by grasping both feet and maintain gentle traction | not used s.t. concern of over extension of the neck
31
what is bracht technique
after spontaneous delivery to the level of umbilicus: body grasped in both handskeeping the leg flexed against babys abdomen and is brought up w/o traction. - usually accompiained by suprapubic pressure against SP ## Footnote favoured in europe
32
what is MAuriceau smellie viet technique
- one hand above the fetus, one finger in occiput and another on each of the fetal shoulders - other hand below the fetus, 2 fingers adjacent to fetal nose on the maxillae (not in fetal mouth-> jaw traction disloaction) - both hands promote flexion of the head, the fetal body raised upwards.
33
percentage of using forceps in vaginal breech delivery
up to 20%
34
what to do in case of fetal head entrapment
1. call for help 2. Mcroberts manoeuvre 3. suprapubic pressure 4. MSV reattempt + suprapubic pressure 5. rotate baby to sacrotransverse position 6. tocolysis: 100ug IV glyceryl tinitrate 7. attempt forceps 8. surgeical management
35
emergency surgical management of fetal head entrapment
1. cx incisions 2. symphysiotomy 3. CS
36
what is duhrssen incisions
- cx incisions - ring forceps to cx in pairs at 2, 6 and 10 oclock - incsion be made bet each pair of forceps
37
rate of cord prolapse in breech
1%
38
Neonatal mortality in vaginal breech birth and CS
VBD: 2/1000 CS: 0.5/1000
39
when to use moxibustion for breech
33-35w
MRCOG - Part 2
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