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DR. RAZAQ O. MASHA, FRCOG Consultant, Ob/Gyn Dept.

BREECH & ABNORMAL PRESENTATIONS. DR. RAZAQ O. MASHA, FRCOG Consultant, Ob/Gyn Dept.

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DR. RAZAQ O. MASHA, FRCOG Consultant, Ob/Gyn Dept.

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  1. BREECH & ABNORMAL PRESENTATIONS DR. RAZAQ O. MASHA, FRCOG Consultant, Ob/Gyn Dept.

  2. Breech presentation occurs in 3-4% of all deliveries. The percentage of breech deliveries decreases with advancing gestational age from 25% of births prior to 28 weeks gestation to 7% of births at 32 weeks gestation to 1-3% of births at term

  3. PREDISPOSING FACTORS  Prematurity  Uterine malformations or fibroids  Placenta praevia  Fetal abnormalities, (e.g. CNS malformations, neck masses)  Multiple gestations Fetal abnormalities are observed in 17% of preterm breech deliveries and 9% of term breech deliveries. Perinatal Mortality is increased 2-4 fold with breech presentation, regardless of the mode of delivery. Deaths are most often associated with malformations, prematurity and intrauterine fetal demise.

  4. TYPES OF BREECHES:  Frank breech (50-70%) – Hips flexed, knees extended  Complete breech (5-10%) – Hips flexed, knees flexed  Footling or incomplete (10-30%) One or both hips extended, foot presenting

  5. EXTERNAL CEPHALIC VERSION (ECV) This is the trans-abdominal manual rotation of the fetus into a cephalic presentation.  Improved outcome may be related to the use of non stress tests both before and after ECV  Improved selection of low-risk fetuses  Rh immune globulin to prevent isoimmunization

  6. PROCEDURE:  Prepare for the possibility of caesarean delivery.  Perform a non-stress test – to confirm fetal well being.  Perform the ECV, in or near a delivery suite  After ECV, repeat the non-stress test.  Administer Rh immune globulin to women who are Rh- negative

  7. RISKS:  Precipitation of labour or premature rupture of membranes  Abruptio placentae  Feto-maternal haemorrhage  Cord entanglement  Fractured fetal bones

  8. CONTRAINDICATIONS:  Multiple gestations  Contra indications to vaginal delivery (e.g. herpes simplex virus infection, placenta praevia)  Non reassuring fetal heart rate tracing

  9. VAGINAL BREECH DELIVERY The three types of vaginal breech deliveries are described:  Spontaneous breech delivery. No traction or manipulation of the infant is used. This occurs predominantly in very preterm deliveries.  Assisted breech delivery: The most common type of vaginal breech delivery.  Total breech extraction. Use for a non cephalic second twin and caesarean deliveries

  10. RISKS: ♣ Lower apgar scores ♣ Fetal head entrapment ♣ Cervical spine injury ♣ Cord prolapse

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