1 / 51

Lecture 6 BREACH PRESENTATION TRANSVERSAL & OBLIQUE LIE

Lecture 6 BREACH PRESENTATION TRANSVERSAL & OBLIQUE LIE. Prof. Vlad TICA , M.D., Ph. D. TYPES OF BREECH PRESENTATION. Frank (65%): Hips are flexed, knees are extended Complete (10%): The hips and knees are flexed Incomplete (25%): The feet or knees are the lowermost presenting part:

lindabrandon
Download Presentation

Lecture 6 BREACH PRESENTATION TRANSVERSAL & OBLIQUE LIE

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Lecture 6BREACH PRESENTATION TRANSVERSAL & OBLIQUE LIE Prof. Vlad TICA, M.D., Ph. D.

  2. TYPES OF BREECH PRESENTATION • Frank (65%): Hips are flexed, knees are extended • Complete (10%): The hips and knees are flexed • Incomplete (25%): The feet or knees are the lowermost presenting part: • Single footling: one of the lower extremities is lowermost. • Double footling: Both of the lower extremities are lowermost

  3. Breech presentations: A: Right sacrum posterior (RSP) position B: Left sacrum anterior (LSA) position

  4. TYPES OF BREECH PRESENTATION • Frank (65%): Hips are flexed, knees are extended • Complete (10%): The hips and knees are flexed • Incomplete (25%): The feet or knees are the lowermost presenting part: • Single footling: one of the lower extremities is lowermost. • Double footling: Both of the lower extremities are lowermost

  5. BREECH PRESENTATION PREDISPOSING FACTORS • Prematurity • Uterine abnormalities • Malformation • Fibroids • Fetal abnormalities • CNS Malformations • Neck Masses • Multiple gestations • Previous breech delivery

  6. BREECH PRESENTATION

  7. BREECH PRESENTATION DIAGNOSIS • Palpation and ballottement • Ultrasound • Pelvic examination • X-Ray studies

  8. BREECH PRESENTATION Leopold Maneuver

  9. EXTERNAL CEPHALIC VERSION

  10. MANAGEMENT

  11. MANAGEMENT • TYPE OF DELIVERY • Vaginal delivery: • Spontaneous • Partial breech extraction • Total breech extraction • Cesarean delivery

  12. TYPES OF VAGINAL BREECH DELIVERY • Spontaneous breech (rare): No manipulation of the infant is necessary, other than supporting the infant • Partial breech extraction: Fetus descend spontaneously to where umbilicus is at the vaginal introitus; then, the fetus is extracted completely • Total breech extraction: The entire body is extracted. This is indicated only if there is evidence of fetal distress unresponsive to routine maneuvers and a cesarean delivery is not possible.

  13. CONDITIONS ARE UNFAVORABLE FOR BREECH DELIVERY • Fetus weight > 3500 g • Unfavorable pelvis – Breech delivery does not allow sufficient time for molding of the fetal head; thus, a platypelloid or android pelvis decreases ability fetal head to navigate maternal pelvis • Hyperextension of the head – increases risk of cervical spine injury • Footlings- incidence of umbilical cord prolapse increases with coiling of the umbilical cord around the legs of the fetus

  14. MORTALITY/MORBIDITY • Increased birth trauma: As duration of umbilical cord compression increases → deliver the infant more rapidly → increasing birth trauma • Decreased birth weight may result from preterm delivery/growth restriction • Incidence of prolapsed umbilical cord depends on type of breech presentation : Footling 17%, Complete 5%, Frank 0,5%

  15. MECHANISM OF LABOR IN BREECH DELIVERY

  16. ASSISTED DELIVERY OF FRANK BREECH

  17. ASSISTED DELIVERY OF FRANK BREECH

  18. ASSISTED DELIVERY OF FRANK BREECH

  19. ASSISTED DELIVERY OF FRANK BREECH • Maneuver for delivery of the head: • The fingers of the left hand are inserted into the infant’s mouth of over mandible; • The right hand exerts pressure on the head from above

  20. MAURICEAU MANEUVER

  21. MECHANISM OF LABOR IN BREECH DELIVERY • Piper forceps • Modified Prague maneuver

  22. DELIVERY OF THE AFTERCOMING HEAD Application of Piper forceps, employing towel sling support. The forceps are introduced from below, left blade first. Aiming directly and intended positions on sides of the head

  23. DELIVERY OF THE AFTERCOMING HEAD

  24. MODIFIED PRAGUE MANEUVER

  25. COMPLETE OR INCOMPLETE BREECH EXTRACTION

  26. COMPLETE OR INCOMPLETE BREECH EXTRACTION

  27. BREECH EXTRACTION

  28. C-SECTION INDICATION • A large fetus ( > 3.500 grams) • A hyperextended fetus • Uterine dysfunction • Footling presentation • Any degree of contraction or unfavorable shape restriction • Previous perinatal death or children suffering from birth trauma

  29. COMPLICATIONS • Perinatal morbidity and mortality from difficult delivery • 2. Low birthweight from preterm delivery, growth restriction, or bot • 3. Prolapsed cord • 4. Placenta praevia • 5. Fetal, neonatal, and infant anomalies • 6. Uterine anomalies and tumors • 7. Multiple fetuses • 8. Operative intervention, especially cesarean delivery

  30. TRANSVERSE OR OBLIQUE PRESENTATION • DEFINITION At the end of pregnancy or during of labor, champ of pelvic inlet is not fetal head or fetal breech 2. VARIETY - shoulder right in dorso-anterior - shoulder left in dorso-anterior - shoulder right in dorso-posterior - shoulder left in dorso-posterior

  31. TRANSVERSE OR OBLIQUE PRESENTATION 3. ETIOLOGY • Mistake of accommodation: the grand cause of transverse position is multipara (relax of uterine wall) • Other cause can hydramnios, previa tumor, shortness umbilical cord • Uterine malformation

  32. TRANSVERSE OR OBLIQUE PRESENTATION 4. CLINICAL • Inspection • The uterus is developing transverse or oblique • Palpation • Hands explored base part of uterus on of pelvic inlet can not contact fetal pole • At middle of uterus fundus have no fetal pole

  33. TRANSVERSE OR OBLIQUE PRESENTATION • At lateral face of uterus (right or left) can contact with fetal pole or breech • Multipara are rare on same plan of transverse • Uterus malformation, the two poles can contact at same higher at uterine body (back in anterior) • In dorso-posterior, abdominal wall perception fetal limps

  34. TRANSVERSE OR OBLIQUE PRESENTATION

  35. TRANSVERSE OR OBLIQUE PRESENTATION • Auscultation: • the fetal cardiac sound can receive a bite under umbilical at cephalic side • Digital exam: • during pregnancy: the excavation is empty (fingers are not contact the presentation)

  36. TRANSVERSE OR OBLIQUE PRESENTATION • During labor: if membranes are not rupture, the sac amniotic fluid is big volume (can not evaluation the presentation) • After rupture of membranes, the fingers are perception: . Shoulder and acromial protrusion . Axillary furrow

  37. TRANSVERSE OR OBLIQUE PRESENTATION • At profound permit contact: . Costal . Scapula • In some cases, superior limp fall down in excavation, vaginal, vulva with character cyanosis and edema • The thumb turn to thigh of mother same name with of shoulder that present

  38. TRANSVERSE OR OBLIQUE PRESENTATION • Diagnostic of variety: must to know head, breech, back, shoulder (right or left) situate at pelvic inlet • When the hand is out side of vulva, sign of thumb confirm the diagnosi • X-ray: necessary in all cases, it confirme diagnostic • Ultrasound: same of x-ray and position of placenta

  39. TRANSVERSE OR OBLIQUE PRESENTATION 5. DELIVERY A. Ovular phenomenon: The precocity of membranes rupture is favorable by character of amniotic fluid sac (big volume in cervical canal) Uterus is empty of amniotic fluid and cord prolapses

  40. TRANSVERSE OR OBLIQUE PRESENTATION

  41. TRANSVERSE OR OBLIQUE PRESENTATION B. Mechanic phenomenon: • First time: weakness, head orient opposite trunk (vertical). The shoulder is in center of basin. Superficial exam, the presentation return longitudinal • Second time: engage of shoulder • Third time: stop of progression (enclave).

  42. TRANSVERSE OR OBLIQUE PRESENTATION C. Plastic phenomenon: • is at region of shoulder, neck, back D. Physiologic phenomenon: • the dilatation of cervix is trouble: cause of dynamic abnormal and ovular infection • The cervix is edema, thick • Lower segment still thick not contact with presentation

  43. TRANSVERSE OR OBLIQUE PRESENTATION • The uterine contraction is the trouble: the contraction is normal until rupture of membrane but the progression of presentation is stopped • First irregular, then inertia or hypertonia with hypercinesis • The consequence of retraction is: • Death of the fetus: the retraction provoke diminution of blood fluid trans placenta and infection

  44. TRANSVERSE OR OBLIQUE PRESENTATION • Uterine rupture: • the retraction of the myometrium of uterine body provoke lower segment stretch (lower segment rupture)

  45. TRANSVERSE OR OBLIQUE PRESENTATION 6. TREATMENT: A. During of pregnancy: - the surveillance of presentation is every days - it can external version for cephalic presentation or breech presentation at pelvic inlet (multipara) - primipara: cesarean section at the end of pregnancy

  46. TRANSVERSE OR OBLIQUE PRESENTATION

  47. TRANSVERSE OR OBLIQUE PRESENTATION

  48. TRANSVERSE OR OBLIQUE PRESENTATION B. During of labor: • Primipara: • cesarean section • Multipara: • The membrane is intact: • Complete dilatation of cervix: artificial rupture of membrane and internal version • Dilatation is incomplete: conservation of membrane until complete dilatation

  49. TRANSVERSE OR OBLIQUE PRESENTATION • The membranes are ruptured: • Uterus is soft (not retracted) & fetus is alive: • cesarean section if incomplete dilatation • internal version if complete dilatation • Uterus is retracted: • Fetus is alive: cesarean section • Fetus is dead: embryotomy

  50. TRANSVERSE OR OBLIQUE PRESENTATION • Uterus is ruptured: • after laparotomy and extraction of fetal mort and placenta, the operation must suture of rupture or hysterectomy

More Related