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BREECH DELIVERY BREECH DELIVERY

BREECH DELIVERY - PowerPoint Presentation

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BREECH DELIVERY - PPT Presentation

Deepa Mishra M Sc Nursing OBG INTRODUCTION A breech birth is the birth of a baby from a breech presentation in which the baby exits the pelvis with the buttocks or feet first as opposed to the normal headfirst presentation In breech presentation fetal heart sounds are heard just above t ID: 229361

head breech delivery presentation breech head presentation delivery felt buttocks feet irregular complete labour clinical birth baby incomplete pelvic

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Slide1

BREECH DELIVERY

Deepa Mishra

M. Sc. Nursing (OBG)Slide2

INTRODUCTION

A breech birth is the birth of a baby from a breech presentation, in which the baby exits the pelvis with the buttocks or feet first as opposed to the normal head-first presentation. In breech presentation, fetal heart sounds are heard just above the umbilicus. In a breech presentation, the lie is longitudinal and the podalic pole presents at the pelvic brim. It is the commonest malpresentation.Slide3

DEFINITION

It is a longitudinal lie in which the buttocks is the presenting part with or without the lower limbs.According to Nima

Bhaskar

A breech birth is the birth of a baby from a breech presentation, in which the baby exits the pelvis with the buttocks or feet first as opposed to the normal head-first presentation.

According

to WikipediaSlide4

INCIDENCE

3-4% of fetus present by breech at term5% at 34 weeks

20%

at 28

weeks

20% diagnosed initially in

labour

3.5%

term singleton deliveries and about 25% of cases before 30 weeks of gestation undergo spontaneous cephalic version up to term.

Slide5

TYPESSlide6

Complete

Breech (Flexed Breech)Slide7

2.

Incomplete Breech(30-35%)Slide8

INCOMPLETE BREECHSlide9

TYPES OF INCOMPLETE BREECHSlide10

CLINICAL VARIETIESSlide11

POSITIONSSlide12

Etiology Of Breech PresentationSlide13

DIAGNOSISSlide14

CLINICAL

 

Complete Breech

Frank Breech

Per Abdomen

 

Fundal Grip

Head-

suggested by hard and globular mass

Head is ballottable

Head

Irregular small parts of the feet may be felt by the side of the head.

Head is non-

ballottable

due to splinting action of the legs on the trunk.

Lateral Grip

Fetal back is to one side and the irregular limbs to the other

Irregular parts are less felt on the sideSlide15

CLINICAL

 

Complete Breech

Frank Breech

Pelvic

Grip

F.H.S.

Breech- suggested by soft, broad and irregular mass.

Breech is usually not engaged during pregnancy

Usually located at a higher level round about the umbilicus

Small, hard and a conical mass is felt

The breech is usually

engaged

Located

at a lower level in the midline due to early engagement of the breech

Per

Vaginum

 

During Pregnancy

During labour

Soft

and irregular parts are felt through the fornix

 

Palpation of

ischial

tuberosities

, sacrum and the feet by the sides of the

buttocks

The foot felt is identified by the prominence of the heel and lesser mobility of the great toe.

Hard

feel of the sacrum is felt, often mistaken for the head

 

 

Palpation of

ischial

tuberosities

, anal opening and sacrum onlySlide16

Ultrasonography

1. It confirms the clinical diagnosis- specially in primigravidae with engaged frank breech or with tense abdominal wall and irritable uterus.2

. It

can detect fetal congenital abnormality and also congenital anomalies of the uterus.

3.

Type

of breech (complete or incomplete).

4.

It

measures

biparietal

diameter, gestational age and approximate weight of the fetus.

5

. It

also localizes the placenta.

6

. Assessment

of liquor volume (important for ECV).

7.

Attitude

of the head- flexion or hyperextension (Important for decision making at the time of delivery).

8. CT

and MRI can be used to assess the pelvic capacity in addition to all the above mentioned information.Slide17

DURING PREGNANCYSlide18

DURING LABOUR

The 3 bony landmarks of breech namely 2

ischial

tuberosities

and tip of the

scarum

.

The feet are felt beside the buttocks in complete breech.

Fresh meconium may be found on the examining fingers.

Male genitalia may be felt.

 Slide19

MECHANISM OF LABOURSlide20

Delivery of ButtocksSlide21

Delivery of ShouldersSlide22

Delivery of HeadSlide23

PROGNOSISSlide24
Slide25
Slide26

External Cephalic VersionSlide27

ELECTIVE CAESARIAN SECTIONSlide28

VAGINAL BREECH DELIVERYSlide29

ASSISTED BREECH DELIVERYSlide30

ASSISTED BREECH DELIVERYSlide31
Slide32

Delayed in Descent of the BreechSlide33

Extended

ArmsSlide34

Arrest

of After Coming HeadSlide35

CONCLUSION

: The incidence of Breech presentation expected to be low in hospitals where high parity births are minimal and routine external cephalic version done in antenatal period. Breech presentation can be managed by early diagnosis and effective management strategies. By using different maneuvers and skillful observation of the obstetrician.Slide36
Slide37
Slide38