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Breech and Abnormal Lie - Coggle Diagram

- - - - Long axis of fetus coresponds to the llong axis of the uterus
        Can be cephalic or breech
    - - Long acis of fetus at a right angle to the long axis of the uterus
    - - Long axis of the fetus crosses the long angle of the uterus at any other angle than the ridht angle
- - - - Knee-chest or head down-left lateral position
      - 2. Manually displacing head upwards
      - Filling bladder - 500ml NaCl via urinary catheter then clamp
      - Wrapping cord in gauze with warm saline
      - Consider tocolysis - terbutaline 0.25mg SC
      - Foetal distress - Category 1 SC performed
        Fetal death may occur due to cord prolapse (deliver via IOL not LSCS)
      - No Foetal distress - Category 2 CS
- - - - CS unless mento-anterior (chin anterior)
    - - CS unless very small baby and parous mother
    - - CS
- - - - Both legs extended at the knee
    - - Both legs flexed at the knee
    - - One or both feet present below buttocks
  - - - Manipulation of fetus externally through maternal abdomen - try to move into cephalic position
      - 50% success rate
        Operator dependent - higher if multiparous
      - 3% return to breech
      - Principles
        
        No anaesthetic
        
        Tocolytic (terbutalin 250mcg SC) to relaxe uterus
        
        Under US guidance
        
        CTG immediately after
        
        Foetal distress - immediate delivery by CS (0.5%)
        
        Anti D to Rh- women
      - Doesn't work for transverse lie
    - - Elective CS at 39 weeks
      - Vaginal breech birth can be attmepted if woman presents spontaneously in labour
        
        Senior consultant obstetrician only with experience
        
        Most patients that labour with breech baby are delivered by caesarean
  - - - Very preterm labour
      - Unexpected breech discovered in advanced labour
      - Delivery of second twin
    - - Hands off approach
        
        Avoid fetal tranction - only apply after spontaneous delivery at level of umbilicus
      - Delivery of Fetal arms
        
        Assist Consider Lovsets maneouvre
        
        Spontaneosu
        
        Usually spontaneous - allow to hang for 30s then try flexion of head
        
        Lovsets
      - Delivery of fetal head
        
        May deliver spontaneous or w assistance of suprapubic pressure
        
        Consider Mariceau-Smellie-Veit maneouvre
        
        Consider Forceps
        
        Mariceau-Smellie-Veit (MSV)
      - Fetal Legs
        
        Usually deliver spontaneously
      - Only apply pressure ot bony prominance